Use of N-methyl-D-aspartate receptor antagonists for postoperative analgesia in proctologic surgery

Authors

Keywords:

N-Methyl aspartate antagonist receptors, ketamine, magnesium sulfate, postoperative analgesia, proctological surgery

Abstract

Introduction: the use of NMDA antagonist receptors has improved the postoperative analgesia, decreasing the requirements of other analgesics.
Objective: to evaluate the utility of the NMDA antagonist receptors for the postoperative analgesia in the proctologic surgery.
Methods: a quasi-experimental study was performed on 100 patients undergoing proctologic surgery, who were divided into two groups. The K group received postoperative analgesia with bolus and infusion ketamine and the KS group received bolus and infusion ketamine and magnesium sulfate in the first 12 hours after surgery. The behavior of mean arterial blood pressure, heart rate, pulsatile oxygen saturation, level of sedation, visual analog scale score for pain, supplemental boluses of rescue analgesia, and adverse effects were evaluated postoperatively.
Results: the behavior of the middle blood tension was better in the KS group. The behavior of the heart rate, oxygen saturation, sedation level, evaluation of the pain throughout the analogical visual scale, rescue analgesia and adverse effects were statistical similar in both groups although with better results in the KS group.
Conclusions: ketamine and magnesium sulfate were useful in the postoperative analgesia in the proctologic surgery and the association ketamine-magnesium sulfate gave better results.

Downloads

Download data is not yet available.

Author Biographies

Carlos Gilberto Nieto Monteagudo, Hospital Universitario "Celestino Hernández Robau"

Especialista en I y II Grado en Anestesiología y Reanimación. Profesor Auxiliar en la Universidad de Ciencias Médicas de Villa Clara.

Osmany Cruz García, Hospital Universitario "Celestino Hernández Robau"

Especialista de I Grado en Anestesiología y Reanimación. Máster en Atención Integral a la Mujer. Profesor Asistente en la Universidad de Ciencias Médicas de Villa Clara.

Greter Nieto Martínez, Hospital Provincial Clínico Quirúrgico Universitario “Arnaldo Milián Castro”

Doctora en Medicina. Residente de Anestesiología y Reanimación.

Lester Álvarez Hurtado, Hospital Universitario "Celestino Hernández Robau"

Especialista en I Grado en Anestesiología y Reanimación. Máster en Urgencias Médicas. Profesor Instructor en la Universidad de Ciencias Médicas de Villa Clara.

Yassel Cruz Hernández, Policlínico Universitario “Chiqui Gómez Lubián”

Doctor en Medicina. Residente de Medicina General Integral.

Marlon Cruz Hernández, Universidad de Ciencias Médicas de Villa Clara

Estudiante de Medicina

References

1. McIntyre MK, Clifford JL, Maani CV, Burmeister DM. Progress of clinical practice on the management of burn-associated pain: Lessons from animal models. Burns [Internet]. 2016 [citado 31/01/2020];42(6):1161-1162. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26906668. https://doi.org/10.1016/j.burns.2016.01.023

2. Chang YC, Liu CL, Liu TP, Yang PS, Chen MJ, Cheng SP. Effect of perioperative intravenous lidocaine infusion on acute and chronic pain after breast surgery: a meta-analysis of randomized controlled trials. Pain Pract [Internet]. 2017 [citado 31/01/2020];17(3):336-343. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26913591. https://doi.org/10.1111/papr.12442

3. Garduño López AL, Nuche Cabrera E, Monroy Álvarez C. Dolor postoperatorio: optimización del manejo en el contexto perioperatorio. Rev Mex Anestesiol Internet]. 2016 [citado 31/01/2020];39(Supl 1):16-19. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=66128

4. Matute Crespo M, Montero Matamala A. Avances farmacológicos en el manejo multimodal de la analgesia postoperatoria. Rev Esp Anestesiol Reanim [Internet]. 2017 [citado 31/01/2020];64(8):467-471. Disponible en: https://medes.com/publication/124011. http://dx.doi.org/10.1016/j.redar.2017.03.006

5. Johnson S, Coxon M. Sound can enhance the analgesic effect of virtual reality. R Soc Open Sci [Internet]. 2016 [citado 31/01/2020];3(3):150567. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821257/. https://doi.org/10.1098/rsos.150567

6. Lin HQ, Jia DL. Effect of preemptive ketamine administration on postoperative visceral pain after gynecological laparoscopic surgery. Med Sci [Internet]. 2016 [citado 31/01/2020];36(4):584-587. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27465337. https://doi.org/10.1007/s11596-016-1629-0

7. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review. JAMA Surg [Internet]. 2017 [citado 31/01/2020];152(7):691-697. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28564673. https://doi.org/10.1001/jamasurg.2017.0898

8. Mulier J. Anestesia libre de opioides: ¿un cambio de paradigma? Rev Esp Anestesiol Reanim [Internet]. 2017 [citado 31/01/2020];64(8):427-430. Disponible en: https://www.elsevier.es/es-revista-revista-espanola-anestesiologia-reanimacion-344-articulo-anestesia-libre-opioides-un-cambio-S0034935617300695. https://doi.org/10.1016/j.redar.2017.03.004

9. Chávez Díaz IF, Nava López JA. Anestesia libre de opioides. La reivindicación de los «adyuvantes». Rev Mex Anestesiol [Internet]. 2015 [citado 31/01/2020];38(Supl 1):S310-S313. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2015/cmas151cc.pdf

10. Mugabure Bujedo B, González Santos S, Uria Azpiazu A, Conejero Morga G, González Jorrín N. Coadyuvantes farmacológicos con efecto ahorrador de opioides en el periodo perioperatorio. Rev Soc Esp Dolor [Internet]. 2018 [citado 31/01/2020];25(5):278-290. Disponible en: http://scielo.isciii.es/pdf/dolor/v25n5/1134-8046-dolor-25-05-00278.pdf. https://doi.org/10.20986/resed.2018.3663/2018

11. De Oliveira GS, Castro Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology [Internet]. 2013 [citado 31/01/2020];119(1):178-190. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23669270. https://doi.org/10.1097/aln.0b013e318297630d

12. Nieto Monteagudo CG, Ramírez Méndez M. Respuesta fisiológica al trauma. En: Caballero López A. Terapia Intensiva. 2da ed. La Habana: Editorial Ciencias Médicas; 2009. p. 1656-1667.

13. Chenge Said J, Campeñacho Asencio MA, Castellanos Acuña MJ. Nuevos usos de la vieja amiga: ketamina. Rev Mex Anestesiol [Internet]. 2016 [citado 31/01/2020];39(Supl 1):S262-S264. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2016/cmas161cm.pdf

14. Navarrete Zuazo VM. La alternativa de la ketamina. Rev Mex Anestesiol [Internet]. 2014 [citado 31/01/2020];37(Supl 1):S243-S250. Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2014/cmas141bn.pdf

15. Navarrete Zuazo VM, Flores Vargas D, Meneses Rodríguez R. Variante de cálculo de infusión de ketamina en la TIVA manual. Rev Cuba Anestesiol Reanim [Internet]. 2018 [citado 31/01/2020];17(3):[aprox. 11 p.]. Disponible en: http://scielo.sld.cu/pdf/scar/v17n3/scar03318.pdf

16. Ye F, Wu Y, Zhou C. Effect of intravenous ketamine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Medicine (Baltimore) [Internet]. 2017 [citado 31/01/2020];96(51):e-9147. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758145/. https://doi.org/10.1097/MD.0000000000009147

17. Lee J, Park HP, Jeong MH, Son JD, Kim HC. Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomized study. J Int Med Res [Internet]. 2018 [citado 31/01/2020];46(3):1109-1120. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972244/. https://doi.org/10.1177/0300060517734679

18. Allen CA, Ivester JR. Low-dose ketamine for postoperative pain management. J Perianesth Nurs [Internet]. 2018 [citado 31/01/2020];33(4):389-398. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/30077280. https://doi.org/10.1016/j.jopan.2016.12.009

19. Stuit D, O´Sullivan C. Ketamine as part of a multimodal approach to postoperative pain management. AANA J [Internet]. 2017 [citado 31/01/2020];85(5):368-374. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31566538/

20. Yetim M, Tekindur S, Eyi YE. Low-dose ketamine infusion for managing acute pain. Am J Emerg Med [Internet]. 2015 [citado 31/01/2020];33(9):1318. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26050558. https://doi.org/10.1016/j.ajem.2015.04.079

21. Jain R, Kochhar N. Influence of difference in timing of perioperative administration of low-dose ketamina on postoperative analgesia. Anesth Essays Res [Internet]. 2017 [citado 31/01/2020];11(2):406-410. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490118/. https://doi.org/10.4103/0259-1162.194538

22. Castro J, Cooney MF. Intravenous magnesium in the management of postoperative pain. J Perianesth Nurs [Internet]. 2017 [citado 31/01/2020];32(1):72-76. Disponible en: https://www.jopan.org/article/S1089-9472(16)30418-X/fulltext. https://doi.org/10.1016/j.jopan.2016.11.007

23. Taheri A, Haryalchi K, Ghanaie MM, Arejan NH. Effect of low-dose (single dose) magnesium sulfate on postoperative analgesia in hysterectomy patients receiving balanced general anesthesia. Anesthesiol Res Pract [Internet]. 2015 [citado 31/01/2020];2015:306145. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330950/. https://doi.org/10.1155/2015/306145

24. Ghaffaripour S, Mahmoudi H, Eghbal H, Rahimi A. The effect of intravenous magnesium sulfate on post-operative analgesia during laminectomy. Cureus [Internet]. 2016 [citado 31/01/2020];8(6):e626. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934929/. https://doi.org/10.7759/cureus.626

25. Shah PN, Dhengle Y. Magnesium sulfate for postoperative analgesia after surgery under spinal anesthesia. Acta Anaesthesiol Taiwanica [Internet]. 2016 [citado 31/01/2020];54(2):62-64. Disponible en: https://www.sciencedirect.com/science/article/pii/S1875459715300163. https://doi.org/10.1016/j.aat.2016.06.003

26. Shin HJ, Kim EY, Na HS, Kim TK, Kim MH, Do SH. Magnesium sulphate attenuates acute postoperative pain and increased pain intensity after surgical injury in staged bilateral total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial. Br J Anaesth [Internet]. 2016 [citado 31/01/2020];117(4):497-503. Disponible en: https://www.sciencedirect.com/science/article/pii/S000709121730171X. https://doi.org/10.1093/bja/aew227

27. Soto Otero Y, Nodal Ortega J. Analgesia multimodal en pacientes histerectomizadas por vía videolaparoscópica. Panorama. Cuba y Salud [Internet]. 2018 [citado 31/01/2020];13(2):33-39. Disponible en: https://www.medigraphic.com/pdfs/cubaysalud/pcs-2018/pcs182e.pdf

28. Schug SA, Peyton P. Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial. Br J Pain [Internet]. 2017 [citado 31/01/2020];11(4):166-168. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661694/. https://doi.org/10.1177/2049463717736076

Downloads

Published

2022-05-31

How to Cite

1.
Nieto Monteagudo CG, Cruz García O, Nieto Martínez G, Álvarez Hurtado L, Cruz Hernández Y, Cruz Hernández M. Use of N-methyl-D-aspartate receptor antagonists for postoperative analgesia in proctologic surgery. Acta Méd Centro [Internet]. 2022 May 31 [cited 2025 Jul. 13];16(3):465-78. Available from: https://revactamedicacentro.sld.cu/index.php/amc/article/view/1726

Issue

Vol. 16 No. 3 (2022): July-September

Section

Original Articles

License

Authors who have publications with this journal agree to the following terms:

  1. Authors will retain their copyright and assign to the journal the right of first publication of their work, which will simultaneously be subject to a Creative Commons License / Attribution-Noncommercial 4.0 International (CC BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.
  2. Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g., depositing it in an institutional repository or publishing it in a monographic volume) as long as the initial publication in this journal is indicated.
  3. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).