CLINICAL STUDY REGARDING PREEMPTIVE
ANALGESIC EFFECT OF KETAMINE AND
REMIFENTANYL IN LAPAROSCOPIC
CHOLECYSTECTOMY
ELENA TRUŢĂ1*, MIHAELA VARTIC2, AURELIA NICOLETA
CRISTEA3
1Departament of Pharmacy, Emergency Clinical Hospital Bucharest, 8
Floreasca Street, Bucharest
2Departament of Anesthesiology, Emergency Clinical Hospital. Bucharest
8 Floreasca Street, Bucharest
3Departament of Pharmacology and Clinical Pharmacy, Faculty of
Pharmacy, 6 Traian Vuia Street, Bucharest
*coresponding author: helen_truta@yahoo.com
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Abstract:

Pain modulation is related to an equilibrium between antinociceptive and pronociceptive systems. Therefore, the apparent pain level could not only be a consequence of a nociceptive input increase but could also result from a pain sensitization process. Glutamate, via N-Methyl –D-aspartate (NMDA) receptors, plays a major role in the development of such a neuronal plasticity in the central nervous system, leading to a pain hypersensitivity that could facilitate chronic pain development. By acting on both NMDA and opioid receptors we can get analgesic effect and prevent chronic pain development. According to these aspects, a clinical study estimating preemptive analgesia with ketamine and remifentanyl in laparoscopic cholecystectomy was designed and carried out. A number of 112 patients divided in five groups were analysed regarding efficiency and safety aspects. All the patients received the same dose of remifentanyl and different doses of ketamine.
The results of the study indicated the best analgesic effect within the group in which the patients received 0.75 μg/kg/min remifentanyl from induction of anaesthesia until suture and ketamine was given in doses of 10 μg/kg/min from induction of anaesthesia and six hours in the postoperative period. Concerning the safety aspect of this scheme the result was less satisfying.

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