Intra-operative low-dose ketamine does not reduce the cost of post-operative pain management after surgery: a randomized controlled trial in a low-income country.
Adult
Analgesics
/ administration & dosage
Analgesics, Opioid
/ administration & dosage
Cost-Benefit Analysis
Double-Blind Method
Female
Humans
Ketamine
/ administration & dosage
Male
Middle Aged
Morphine
/ administration & dosage
Pain Management
/ economics
Pain, Postoperative
/ drug therapy
Poverty
/ statistics & numerical data
Uganda
Post-operative pain management
RCT
ketamine
low-income country
Journal
African health sciences
ISSN: 1729-0503
Titre abrégé: Afr Health Sci
Pays: Uganda
ID NLM: 101149451
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
entrez:
5
3
2020
pubmed:
5
3
2020
medline:
30
9
2020
Statut:
ppublish
Résumé
In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings. The aim of this study was to explore the overall reduction in the medication treatment cost of acute post-operative pain by adding intra-operative low-dose ketamine to traditional intravenous morphine for surgery in a low-income country. A double blind randomized controlled trial with placebo-controlled parallel group was performed in Mulago National Hospital (Uganda). Consenting adults scheduled for elective surgery were randomized into two study arms: Group K received ketamine 0.15mg/kg bolus at induction and a continuous infusion of 0.12 mg/kg/hour till start of skin closure; Group C (control) received normal saline. Both groups received Morphine 0.1 mg/kg IV at debulking. The total medication cost was registered. NRS pain scores and other measurements such vital signs and incidence of major and minor side effects were also recorded. A total of 46 patients were included. Patients' baseline characteristics were comparable in both groups. No statistically significant difference was found between the groups concerning the overall medication cost of post-operative pain management. Pain scores, patients' satisfaction in the first 24 hours after surgery and hospital length of stay were similar in both groups. Our results do not support the utilization of intra-operative low dose ketamine as a cost-saving post-operative pain treatment strategy for all types of surgery in low-resource settings.
Sections du résumé
BACKGROUND
BACKGROUND
In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings.
OBJECTIVES
OBJECTIVE
The aim of this study was to explore the overall reduction in the medication treatment cost of acute post-operative pain by adding intra-operative low-dose ketamine to traditional intravenous morphine for surgery in a low-income country.
METHODS
METHODS
A double blind randomized controlled trial with placebo-controlled parallel group was performed in Mulago National Hospital (Uganda). Consenting adults scheduled for elective surgery were randomized into two study arms: Group K received ketamine 0.15mg/kg bolus at induction and a continuous infusion of 0.12 mg/kg/hour till start of skin closure; Group C (control) received normal saline. Both groups received Morphine 0.1 mg/kg IV at debulking. The total medication cost was registered. NRS pain scores and other measurements such vital signs and incidence of major and minor side effects were also recorded.
RESULTS
RESULTS
A total of 46 patients were included. Patients' baseline characteristics were comparable in both groups. No statistically significant difference was found between the groups concerning the overall medication cost of post-operative pain management. Pain scores, patients' satisfaction in the first 24 hours after surgery and hospital length of stay were similar in both groups.
CONCLUSION
CONCLUSIONS
Our results do not support the utilization of intra-operative low dose ketamine as a cost-saving post-operative pain treatment strategy for all types of surgery in low-resource settings.
Identifiants
pubmed: 32127889
doi: 10.4314/ahs.v19i4.35
pii: jAFHS.v19.i4.pg3127
pmc: PMC7040337
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Ketamine
690G0D6V8H
Morphine
76I7G6D29C
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
3127-3135Informations de copyright
© 2019 Ragazzoni et al.
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