Subcutaneous ketamine for postoperative pain relief in Rwanda: a randomized clinical trial

Purpose Postoperative pain control is often inadequate in low-income countries such as Rwanda, prompting the search for an inexpensive improvement. A randomized controlled trial was conducted to study the use of subcutaneous ketamine for the management of postoperative pain in patients undergoing ma...

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Bibliographic Details
Published in:Canadian journal of anesthesia 2018-02, Vol.65 (2), p.170-177
Main Authors: Sacevich, Calen, Semakuba, Benjamin, McKay, William P., Thakore, Shefali, Twagirumugabe, Theogene, Nyiligira, John
Format: Article
Language:English
Subjects:
Adult
Analgesics - administration & dosage
Analgesics - adverse effects
Anesthesia
Anesthesiology
Cardiology
Clinical trials
Critical Care Medicine
Developing Countries
Double-Blind Method
Drug administration
Female
Hallucinations
Humans
Hypertension
Injections, Subcutaneous
Intensive
Ketamine
Ketamine - administration & dosage
Ketamine - adverse effects
Male
Medicine
Medicine & Public Health
Middle Aged
Narcotics
NCT
NCT02514122
Pain
Pain management
Pain Measurement
Pain Medicine
Pain, Postoperative - drug therapy
Patients
Pediatrics
Pneumology/Respiratory System
Postoperative Care - methods
Postoperative period
Reports of Original Investigations
Rwanda
Studies
Surgery
Surgical Procedures, Operative - methods
Young Adult
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Summary:Purpose Postoperative pain control is often inadequate in low-income countries such as Rwanda, prompting the search for an inexpensive improvement. A randomized controlled trial was conducted to study the use of subcutaneous ketamine for the management of postoperative pain in patients undergoing major surgery in Kigali, Rwanda. Methods Fifty-nine patients undergoing major abdominal, head and neck, plastic, or gynecological surgeries were studied. In addition to standard care, patients received five subcutaneous injections of ketamine 1 mg·kg −1 (ketamine group, n = 30) or normal saline (placebo group, n = 29 ) during the postoperative period. The first injection was administered in the postanesthesia care unit and then every 12 hr thereafter starting at 20:00 on the day of surgery. Pain was assessed three times per day using an 11-point verbal response scale. Patients were also assessed for side effects, including nausea and vomiting, hallucinations, nightmares, sedation, hypertension, and seizures. Results The mean (SD) overall postoperative pain scale score was higher in the control group than in the ketamine group [4.8 (1.7) vs 3.7 (1.5), respectively; difference of means, 1.1; 95% confidence interval [CI], 0.3 to 1.9; P = 0.009]. Brief hallucinations (ketamine group, 11 patients; placebo group, 0 patients; risk difference, 0.37; 95% CI, 0.18 to 0.54; P < 0.001) were associated with ketamine administration. Conclusions Results of this study in Kigali, Rwanda showed that subcutaneous administration of ketamine 1 mg·kg −1 twice daily, in addition to standard postoperative care, produced a small improvement in postoperative pain but resulted in more minor side effects Trial registration www.clinicaltrials.gov (NCT02514122). Registered 31 July 2015.
ISSN:0832-610X
1496-8975
DOI:10.1007/s12630-017-1009-7