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Effects of Adding Low-Dose Ketamine to Remifentanil-Midazolam Infusion Under Topical Anesthesia on Pain Relief After Nasal Bone Fracture



Rahimi M1 ; Honarmand A1 ; Naderi F2 ; Safavi SMR1 ; Heidari SM1
Authors
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Authors Affiliations
  1. 1. Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Journal of Isfahan Medical School Published:2012

Abstract

Background: Pain relief after nasal bone fracture surgery is unsatisfactory. The present study aimed to evaluate the effects of adding low-dose ketamine to remifentanil-midazolam infusion under topical anesthesia on pain relief after nasal bone fracture. Methods: In a controlled study, 68 nasal bone fracture surgery candidates were allocated to two groups receive infusion of 2 μg/kg remifentanil and 0.05 mg/kg midazolam plus 0.5 mg/kg of either ketamine (ketamine group) or placebo (control group). Pain intensity was assessed using a visual analogue scale. Patient satisfaction and the amount of rescue analgesic used were recorded until 60 minutes after surgery. Repeated measures analysis of variance (ANOVA) was used to analyze the data. Findings: In the ketamine group, pain intensity 0, 15, 30, 45, and 60 minutes after operation was 3.5 ± 2.1, 1.2 ± 2.0, 1.8 ± 2.4, 1.3 ± 2.1, and 1.9 ± 2.2, respectively. The corresponding values in the control groups were 3.7 ± 2.2, 8.6 ± 2.0, 4.7 ± 1.2, 3.1 ± 1.2, and 3.7 ± 0.9. The difference between the two groups was statistically significant (P = 0.001). Moreover, patient satisfaction in the ketamine group was higher than the control group (P = 0.005). The dosage of rescue pethidine was significantly lower in the ketamine group compared to the control group (P = 0.045). Conclusion: This study showed that adding 0.5 mg/kg ketamine to 2 μg/kg remifentanil and 0.05 mg/kg midazolam improved postoperative pain relief.
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