摘要
Objective： To investigate the adjuvant effect of intraoperative and postoperative low-dose ketamine administration to remifentanil consumption in patient-controlled analgesia （PCA） for lower limb fracture. Methods： A total of 200 patients with lower limb fracture receiving the surgery were randomly divided into 4 groups. In Groups A, B and C, patients received 0.5 mg/kg ketamine infusion under general anesthesia, and ketamine in a dose of 0.1 mg/kg, 0.05 mg/kg, 0.01 mg/kg per hour continuously for 24 hours after surgery, respectively. The control group （Group D） received an equivalent volume of normal saline only. With 20 μg/ml remifentanil in normal saline, postoperative PCA was administered with a background infusion at 2 ml/h following 2 ml as a loading dose and lml demand dose with a 3-minute lockout period. Remifentanil consumption, 11-point visual analog scale （VAS） scores, global satisfaction score （GSS）, and side effects were also recorded by the acute pain service. Results： Cumulative PCA remifentanil consumption in Groups A and B were （1378±377）μg and （1531±402） μg, significantly lower than （1807±510） μg and （1838±523） μg in Groups C and D （P〈 0.01）. VAS scores in Groups A and B were significantly lower than those in Groups C and D （P〈 0.01）. In the first 12 hours after operation, GSS was improved （P〈0.01）. No respiratory depression was observed. No significant difference in side effects was observed among groups. Conclusion： Low-dose ketamine can relieve postoperative pain and moderately decrease remifentanil consumption for PCA, with no obvious side effects of ketamine.
