مقایسه تاثیر کتامین و پتدین در کنترل درد بیماران معتاد تحت جراحی شکستگی پروکسیمال هومروس تاثیر کتامین و پتدین در کنترل درد بیماران معتاد
مجله آنستزیولوژی و مراقبتهای ویژه ایران,
Vol. 2 No. 124 (1402),
16 May 2026
Abstract
هدف: باتوجه به پیشرفت هایی که در علم پزشکی بوجود آمده اما درد پس از عمل جراحی یکی از مشکلات کادر درمان می باشد. به علت عوارض و مقاومت به اوپیوئیدها در بیماران معتادف توجه به داروهای کمکی نظیر کتامین افزایش یافته است. از اینرو هدف از انجام تحقیق مقایسه تاثیر کتامین و پتدین در کنترل درد بیماران معتاد تحت جراحی شکستگی پروکسیمال هومروس بود. مواد و روش ها: 30 بیمار کاندید عمل جراحی شکستگی پروکسیمال هومروس مراجعه کننده به بیمارستان اختر و امام حسین انتخاب و به صورت تصادفی در دو گروه کتامین و پتدین قرار گرفتند. گروه کتامین 5/0 میلی گرم بر کیلوگرم و حجم 2سی سی، گروه پتدین نیز پتدین را با دوز 5/0میلی گرم بر کیلوگرم و حجم 2سی سی بعد از القای بیهوشی و قبل از شروع عمل جراحی دریافت کردند. 2، 4، 6، 12 و 24 ساعت بعد از آن میزان کنترل درد با استفاده از مقیاس دیداری درد VAS اندازه گیری شد. داده ها با استفاده از آزمون تی مستقل تحلیل شدند. یافته ها: یافته ها نشان داد که بین میزان شدت درد در گروه کتامین و پتدین در همه زمان ها تفاوت معنی داری وجود داشت و شدت درد در گروه کتامین نسبت به گروه پتدین کمتر بوده است. نتیجه گیری: در کل با توجه به نتایج تحقیق می توان نتیجه گرفت که کتامین در عمل های جراحی شکستگی پروکسیمال هومروس در بیماران معتاد داروی بهتری نسبت به پتدین در کنترل درد می باشد. Objective: Despite advances in medical science, post-operative pain remains a significant challenge for healthcare providers. Due to the adverse effects and resistance to opioids in addicted patients, adjunct medications such as ketamine have garnered increasing attention. This study aimed to compare the effects of ketamine and pethidine on pain management in addicted patients undergoing proximal humerus fracture surgery. Materials and Methods: A total of 30 opium addicted patients scheduled for proximal humerus fracture surgery, referred to in Akhtar and Imam Hussein Hospitals, were selected and randomly assigned into two groups: ketamine and pethidine. The ketamine group received 0.5 mg/kg (2 ml volume), while the pethidine group received 0.5 mg/kg (2 ml volume) of the respective drugs immediately after anesthesia induction and before the start of surgery. Pain levels were measured at 2, 4-, 6-, 12-, and 24-hour post-operation using the Visual Analog Scale (VAS). Data was analyzed using independent t-tests. Results: The findings demonstrated a significant difference in pain intensity between the ketamine and pethidine groups at all measured time points, with the ketamine group experiencing lower pain scores compared to the pethidine group. Conclusion: Overall, based on the results of this study, ketamine appears to have more impact. Effective analgesic than pethidine in managing post-operative pain in addicted patients undergoing proximal humerus fracture surgery.- بیماران معتاد
- بیدردی
- جراحی
- بیهوشی
How to Cite
References
Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. Journal of orthopaedic trauma. 2015;29(8):e242-e4.
Kim SH, Szabo RM, Marder RA. Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis care & research. 2012;64(3):407-14.
Chu SP, Kelsey JL, Keegan TH, Sternfeld B, Prill M, Quesenberry CP, Sidney S. Risk factors for proximal humerus fracture. American journal of epidemiology. 2004;160(4):360-7.
Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. LWW; 2013.
Spross C, Meester J, Mazzucchelli RA, Puskás GJ, Zdravkovic V, Jost B. Evidence-based algorithm to treat patients with proximal humerus fractures—a prospective study with early clinical and overall performance results. Journal of shoulder and elbow surgery. 2019;28(6):1022-32.
Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database of Systematic Reviews. 2022(6).
Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults—a systematic review of management. Injury. 2001;32(5):363-72.
Lachiewicz PF. The role of intravenous acetaminophen in multimodal pain protocols for perioperative orthopedic patients. Orthopedics. 2013;36(2):15-9.
Arroyo-Novoa CM, Figueroa-Ramos MI, Miaskowski C, Padilla G, Paul SM, Rodríguez-Ortiz P, et al. Efficacy of small doses of ketamine with morphine to decrease procedural pain responses during open wound care. The Clinical journal of pain. 2011;27(7):561-6.
Honarmand A, Safavi M, Karaky H. Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy. Journal of pain research. 2011:1-6.
Durmus M, Kadir But A, Saricicek V, Ilksen Toprak H, Ozcan Ersoy M. The post‐operative analgesic effects of a combination of gabapentin and paracetamol in patients undergoing abdominal hysterectomy: a randomized clinical trial. Acta anaesthesiologica scandinavica. 2007;51(3):299-304.
Martin TJ, Eisenach JC. Pharmacology of opioid and nonopioid analgesics in chronic pain states. Journal of Pharmacology and Experimental Therapeutics. 2001;299(3):811-7.
Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. Journal of Neuroscience. 2003;23(3):876-82.
Annetta MG, Iemma D, Garisto C, Tafani C, Proietti R. Ketamine: new indications for an old drug. Current drug targets. 2005;6(7):789-94.
Ivani G, Vercellino C, Tonetti F. Ketamine: a new look to an old drug. Minerva anestesiologica. 2003;69(5):468-71.
Rezagholi P, Goharrizi MASB, Ghiasi MS. The Effect of Ketamine on the Hemodynamic status and Postoperative Pain in Addict Patients Undergoing Cardiac Surgery: A Double-Blind Clinical Trial. 2018.
Way WL. Opioid analgesics and antagonists. Basic and clinical pharmacology. 1998:496-515.
Imani F, Salmanian R, Feiz H. Comparison of co-administration of clonidine and pethidine with bupivacaine during spinal anesthesia. Zahedan Journal of Research in Medical Sciences. 2011;13(2).
Ghahiri AA, Fereidoni F, Abdi F, Kian Sadr O. Comparison study on effect of intramuscular petidin injection against intra venues patient control analgesia (PCA) after elective cesarean section. Journal of Isfahan Medical School. 2011;29(130):215-21.
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-26.
Mokkink LB, Terwee CB, van Lummel RC, de Witte SJ, Wetzels L, Bouter LM, de Vet HC. Construct validity of the DynaPort® KneeTest: a comparison with observations of physical therapists. Osteoarthritis and Cartilage. 2005;13(8):738-43.
ENTEZARI S, IMANI F, ABDOLLAHZADE BA. Effect of adding Ketamin to the combination of Morphine and Midazolam in opioid tolerant patients on post operative pain. 2015.
Imani F, ENTEZARY SR, FAIZ SHR, ALEBOUYEH MR, Nikpour K. Comparing the analgesic effects of adding Ketamine to Morphine with Tramadol after major abdominal surgery under general anesthesia. 2011.
NAJAFI N, HOSSEINI H, HATAMI M, VAKILI M, Shishebor F, ZAMANIAN M, HAKIMIZADEH E. Effect of adding Ketamine to morphine in patient controlled analgesia of patients addicted to opioid with post orthopedic operation pain. 2018.
G G, G B. The effect of intravenous ketamine and pethidine on postoperative shivering in surgical patients under general anesthesia in Tikur anbessa specialized hospital, Addis Ababa, Ethiopia: A prospective observational cohort study. 2021.
Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, Beach ML. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. The Journal of the American Society Of Anesthesiologists. 2010;113(3):639-46.
Park S, Choi AY, Park E, Park HJ, Lee J, Lee H, et al. Effects of continuous ketamine infusion on hemodynamics and mortality in critically ill children. PLoS One. 2019;14(10):e0224035.
Cogan J, Lalumière G, Vargas-Schaffer G, Deschamps A, Yegin Z. Low-dose intravenous ketamine for postcardiac surgery pain: effect on opioid consumption and the incidence of chronic pain. Annals of Cardiac Anaesthesia. 2017;20(4):395-8.
Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain. 1999;82(2):111-25.
Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, Chauvin M. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. The Journal of the American Society of Anesthesiologists. 2005;103(1):147-55.
Dickenson A. NMDA receptor antagonists: interactions with opioids. Acta anaesthesiologica scandinavica. 1997;41(1):112-5.
Javery KB, Ussery TW, Steger HG, Colclough GW. Comparison of morphine and morphine with ketamine for postoperative analgesia. Canadian Journal of Anaesthesia. 1996;43:212-5.
Reeves M, Lindholm DE, Myles PS, Fletcher H, Hunt JO. Adding ketamine to morphine for patient-controlled analgesia after major abdominal surgery: a double-blinded, randomized controlled trial. Anesthesia & Analgesia. 2001;93(1):116-20.
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