The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Influence of Ketamine and Midazolam on the Analgesic Effect of Epidural Bupivacaine and Fentanyl after Low Abdominal Surgery

하복부수술 후 경막외 부피바케인과 펜타닐에 첨가한 케타민과 미다졸람의 제통효과

  • Jung, Jai Yun (Department of Anesthesiology and Pain Medicine, Sanbon Hospital, Wonkwang University) ;
  • Park, Sun Young (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital) ;
  • Kim, Yong Ik (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital)
  • 정재윤 (원광대학교 의과대학 산본병원 마취통증의학교실) ;
  • 박선영 (순천향대학교 의과대학 부천병원 마취통증의학교실) ;
  • 김용익 (순천향대학교 의과대학 부천병원 마취통증의학교실)
  • Received : 2006.03.28
  • Accepted : 2006.05.22
  • Published : 2006.06.30
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Abstract

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

Keywords

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