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Intrathecal ketamine

Veerandra Koyyalamudi, Sudipta Sen, Shilpadevi Patil, Justin B Creel, Elyse M Cornett, Charles J Fox, Alan D Kaye
PURPOSE OF REVIEW: A majority of surgical practice has involved ambulatory centers with the number of outpatient operations in the USA doubling to 26.8 million per year. Local anesthesia delivery provides numerous benefits, including increased satisfaction, earlier discharge, and reduction in unplanned hospital admission. Further, with the epidemic of opioid mediated overdoses, local anesthesia can be a key tool in providing an opportunity to reduce the need for other analgesics postoperatively...
January 2017: Current Pain and Headache Reports
Berenice Carolina Hernández-Porras, Ricardo Plancarte-Sánchez, Silvia Alarcón-Barrios, Marcela Sámano-García
BACKGROUND: Complex regional pain syndrome is characterized by spontaneous or induced pain disproportionate in relation to the initial event and is accompanied by a variety of regional and motor disturbances, leading to a variety of clinical presentations. It is often associated with surgery and minor trauma. PATHOPHYSIOLOGY: Three mechanisms are postulated: changes secondary to post traumatic inflammation, peripheral vasomotor dysfunction and structural and functional changes of the central nervous system as a result of maladaptation...
December 19, 2016: Cirugia y Cirujanos
Yan Zhang, Hong Lin, Wen-Bo Yi
Spinal anesthesia or regional anesthesia is a potent anesthetic procedure. Additional modalities have been sought to increase the duration of block in spinal anesthesia. Ketamine is an N-methyl-D-aspartate (NMDA) receptor blocker that has an anesthetic effect when injected intrathecally and has a synergic effect with bupivacaine. Ketamine also has potent analgesic properties. The present study investigated the effect of intrathecally administered ketamine on spinal anesthesia with levobupivacaine or ropivacaine...
October 2016: Experimental and Therapeutic Medicine
Ali Solhpour, Alireza Jafari, Masoud Hashemi, Behnam Hosseini, Sajad Razavi, Gholamreza Mohseni, Maryam Vosoughian, Faranak Behnaz, Reza Amin Nejad, Mohamad Amin Pourhoseingholi, Fereshteh Soltani
STUDY OBJECTIVES: The aim of this study is to compare the efficacy of combination of meperidine and dexamethasone with that of placebo, meperidine alone, and the combination of ketamine and midazolam in preventing shivering during spinal anesthesia. DESIGN: This is a prospective, placebo-controlled study. SETTING: The setting is at an operating room of a university-based teaching hospital. PATIENTS: Two hundred American Society of Anesthesiologists I and II patients undergoing orthopedic and urologic surgery under spinal anesthesia were included...
November 2016: Journal of Clinical Anesthesia
Jiehao Sun, Hai Lin, Xiaona Feng, Jiaojiao Dong, Emmanuel Ansong, Xuzhong Xu
BACKGROUND: Activation of NMDA receptors play an important role in the development of remifentanil-induced hyperalgesia. We hypothesized that in addition to ketamine, intrathecal MgSO4 could also relieve thermal and mechanical hyperalgesia in rats. METHODS: Initially, 24 Sprague-Dawley rats were divided into control group, remifentanil group, surgical incision group and remifentanil combined with surgical incision group to create an experimental model. Subsequently, 40 rats were divided into control group, model group, model group plus 100 μg MgSO4, 300 μg MgSO4 and 10 μg ketamine respectively...
2016: BMC Anesthesiology
Sahar Abd-Elbaky Mohamed, Ahmad Mohammad Abd El-Rahman, Khaled M Fares
BACKGROUND: Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. OBJECTIVE: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. DESIGN: Double-blinded, randomized, controlled trial. SETTING: Academic medical center...
July 2016: Pain Physician
Marzieh Beigom Khezri, Elham Tahaei, Amir Hossein Atlasbaf
OBJECTIVES: To compare the analgesic efficacy of intrathecal Ketamine and fentanyl added to bupivacaine in patients undergoing cesarean section. METHODS: Ninety patients 18-40 years old were recruited in a prospective double-blinded, randomized way. Spinal anesthesia was performed in the three groups by using bupivacaine 10mg combined with 0.1mg/kg ketamine in group K, bupivacaine 10mg combined with 25 µg fentanyl in group F and bupivacaine 10mg combined 0.5 ml distilled water in group P...
February 2016: Middle East Journal of Anesthesiology
M Aleman, E Davis, H Knych, A Guedes, F Smith, J E Madigan
BACKGROUND: Intrathecal lidocaine hydrochloride under general anesthesia has been used as an alternative method of euthanasia in equids. Carnivore, scavenger, and even human consumption of horse meat from carcasses have been anecdotally reported in rural areas after this method of euthanasia. The presence of drug residues in horse meat has not been investigated. HYPOTHESIS/OBJECTIVES: To investigate if drug residues are found in horse tissues and determine their concentrations...
July 2016: Journal of Veterinary Internal Medicine
Sisinti Sanjeeb Patro, Hemant Deshmukh, Yerramalli Roja Ramani, Gitanjali Das
INTRODUCTION: Various adjuvants like morphine, buprenorphine and fentanyl, clonidine, ketamine are being used in anaesthetic practice since long for improvement of peri-operative analgesia following spinal anaesthesia. Such adjuvants have been helpful in induction of early ambulation but at the cost of their associated adverse effects. Therefore search for an effective adjuvant is still going on. Currently Dexmedetomidine, a highly selective α2-adrenoreceptor agonist is being studied for its adjuvant action in spinal anaesthesia...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Ahmed Sobhy Basuni
BACKGROUND AND AIMS: Spinal anesthesia for cesarean section (CS) is associated with an incidence of hypotension of 60-94%. This study hypothesizes that intrathecal combination of low-dose ketamine, midazolam, and low-dose bupivacaine improves hemodynamics and postoperative analgesia compared with fentanyl and low-dose bupivacaine during CS. MATERIAL AND METHODS: Fifty parturients undergoing elective CS were randomized equally to receive ketamine (10 mg), midazolam (2 mg) and 0...
January 2016: Journal of Anaesthesiology, Clinical Pharmacology
Jijun Xu, Jing Yang, Peirong Lin, Ellen Rosenquist, Jianguo Cheng
Complex regional pain syndrome (CRPS) remains a challenging clinical pain condition. Multidisciplinary approaches have been advocated for managing CRPS. Compared with spinal cord stimulation and intrathecal targeted therapy, IV treatments are less invasive and less costly. We aimed to systemically review the literature on IV therapies and determine the level of evidence to guide the management of CRPS. We searched PubMed, Embase, Scopus, and the Cochrane databases for articles published on IV therapies of CRPS up through February 2015...
March 2016: Anesthesia and Analgesia
Alonso Guedes, Monica Aleman, Eric Davis, Caitlin Tearney
OBJECTIVE: To determine physiologic responses to apnea-induced severe hypoxemia in anesthetized horses. STUDY DESIGN: Prospective experimental study. ANIMALS: Six university-owned horses with a median (range) body weight of 500 (220-510) kg and aged 13.5 (0.8-24.0) years scheduled for euthanasia. METHODS: Xylazine-midazolam-ketamine-anesthetized horses breathing room air spontaneously were instrumented with a facial artery catheter for pressure measurement and blood sampling, and were made apneic with atlanto-occipital intrathecal lidocaine (4 mg kg(-1) )...
November 2016: Veterinary Anaesthesia and Analgesia
Hugh D de Pereira Cardoso, Natalie C Fim, Mariangela A Marques, Helio Mint, Vania M de Vasconcelos Machado, Daneshvari R Solanki, Rodrigo Moreira Lima, Ana L de Carvalho, Lais H Navarro, Eliana M Ganem
BACKGROUND: There is experimental evidence that dexmedetomidine has neuroprotective effects. So, it could be expected that its intrathecal or epidural administration presents no harm. However, whether dexmedetomidine is neurotoxic to the spinal cord remains to be fully elucidated. OBJECTIVE: To evaluate the effect of preservative-free dexmedetomidine administered as a subarachnoid single injection on the spinal cord and meninges of rabbits. STUDY DESIGN: Research article...
February 2016: Pain Physician
Paul A Tripi, Matthew E Kuestner, Connie S Poe-Kochert, Kasia Rubin, Jochen P Son-Hing, George H Thompson, Joseph D Tobias
INTRODUCTION: The unique pharmacokinetic properties of remifentanil with a context-sensitive half-life unaffected by length of infusion contribute to its frequent use during anesthetic management during posterior spinal fusion in children and adolescents. However, its intraoperative administration can lead to increased postoperative analgesic requirements, which is postulated to be the result of acute opioid tolerance with enhancement of spinal N-methyl-D-aspartate receptor function. Although strategies to prevent or reduce tolerance have included the coadministration of longer acting opioids or ketamine, the majority of these studies have demonstrated little to no benefit...
2015: Journal of Pain Research
Saïd M'Dahoma, Sandrine Barthélemy, Claire Tromilin, Tiffany Jeanson, Florent Viguier, Benoit Michot, Sophie Pezet, Michel Hamon, Sylvie Bourgoin
Numerous reported data support the idea that Brain Derived Neurotrophic Factor (BDNF) is critically involved in both depression and comorbid pain. The possible direct effect of BDNF on pain mechanisms was assessed here and compared with behavioral/neurobiological features of neuropathic pain caused by chronic constriction injury to the sciatic nerve (CCI-SN). Sprague-Dawley male rats were either injected intrathecally with BDNF (3.0 ng i.t.) or subjected to unilateral CCI-SN. Their respective responses to anti-hyperalgesic drugs were assessed using the Randall-Selitto test and both immunohistochemical and RT-qPCR approaches were used to investigate molecular/cellular mechanisms underlying hyperalgesia in both models...
November 2015: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
M Aleman, E Davis, D C Williams, J E Madigan, F Smith, A Guedes
BACKGROUND: An intravenous (IV) overdose of pentobarbital sodium is the most commonly used method of euthanasia in veterinary medicine. However, this compound is not available in many countries or rural areas resulting in usage of alternative methods such as intrathecal lidocaine administration after IV anesthesia. Its safety and efficacy as a method of euthanasia have not been investigated in the horse. HYPOTHESIS/OBJECTIVES: To investigate changes in mean arterial blood pressure and electrical activity of the cerebral cortex, brainstem, and heart during intrathecal administration of lidocaine...
November 2015: Journal of Veterinary Internal Medicine
Isabela Leite Ferraz, Guilherme Antônio Moreira de Barros, Patrícia Gomes Ferreira Neto, Daneshivari Solanki, Mariângela Alencar Marques, Vânia Maria de Vasconcelos Machado, Lucas Wynne Cabral, Rodrigo Moreira E Lima, Pedro Thadeu Galvão Vianna, Lais Helena Camacho Navarro, Eliana Marisa Ganen
BACKGROUND AND OBJECTIVES: Although there is no documented evidence that tattoo pigments can cause neurological complications, the implications of performing neuraxial anesthesia through tattooed skin are unknown. In this study, we aimed to assess whether spinal puncture performed through tattooed skin of rabbits determines changes over the spinal cord and meninges. In addition, we sought to evaluate the presence of ink fragments entrapped in spinal needles. METHODS: Thirty-six young male adult rabbits, each weighing between 3400 and 3900 g and having a spine length between 38...
September 2015: Regional Anesthesia and Pain Medicine
Sadegh Abdolmohammadi, Pierre-Olivier Hétu, Andrée Néron, Gilbert Blaise
The aim of the present study was to explore the effectiveness of an alternative method to manage pain based on a time-limited intrathecal (IT) infusion of an analgesic medication mixture. Three patients (69, 64 and 94 years of age) with intractable and poorly controlled pain due to bed sores, pelvic metastatic mass, and thoracic vertebra and rib fractures, respectively, were treated. Daily doses of opioids could not be increased due to side effects. An IT catheter (20 G) was placed by percutaneous approach in the lumbar area while advancing toward the thoracic region, and was then tunnelled and fixed subcutaneously...
May 2015: Pain Research & Management: the Journal of the Canadian Pain Society
Felicity Y Han, Kristofer J Thurecht, Ai-Leen Lam, Andrew K Whittaker, Maree T Smith
Intractable cancer-related pain complicated by a neuropathic component due to nerve impingement is poorly alleviated even by escalating doses of a strong opioid analgesic. To address this unmet medical need, we developed sustained-release, bioerodable, hydromorphone (potent strong opioid)- and ketamine (analgesic adjuvant)-loaded microparticles for intrathecal (i.t.) coadministration. Drug-loaded poly(lactic-co-glycolic acid) (PLGA) microparticles were prepared using a water-in-oil-in-water method with evaporation...
July 2015: Journal of Pharmaceutical Sciences
Chalinee Monsereenusorn, Piya Rujkijyanont, Chanchai Traivaree
BACKGROUND: Children often require relief of pain and anxiety when undergoing painful procedures. OBJECTIVE: To determine the differences by comparing fentanyl and ketamine used in cancer-diagnosed children undergoing painful procedures. MATERIAL AND METHOD: A randomized, double-blinded, crossover trial was conducted with 55 children undergoing painful procedures (intrathecal chemotherapy and/or bone marrow aspiration/biopsy). Patients were randomly assigned in a double-blinded fashion to receive either intravenous fentanyl or ketamine at 1 mcg/kg/dose and 1 mg/kg/dose, respectively...
April 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
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