Pre-emptive Analgesia with Ketamine and Morphine: a Clinical Study

Authors: J. Málek 1;  A. Kurzová 1;  I. Kraus 2
Authors‘ workplace: Klinika anesteziologie a resuscitace, UK 3. LF a FNKV, Praha 1;  Klinika gynekologie a porodnictví UK 3. LF a FNKV, Praha 2
Published in: Anest. intenziv. Med., 16, 2005, č. 3, s. 138-142
Category: Anaesthesiology - Original Paper


To assess if a pre-emptive combination of morphine and ketamine is more effective than if one drug is administered before surgery and the second one after a surgical stimulation.

Prospective single-blinded randomized clinical study.

Charles University, Prague, 3rd Medical Faculty, Dept. of Anaesthesiology and Intensive Care.

Material and Method:
A total of 63 women scheduled for abdominal hysterectomy were randomly divided in three equal groups. Only atropine and diazepam were used for premedication. The group K was administered ketamine 0.6 mg . kg-1 + normal saline (NS) i. v. before induction to general anaesthesia (GA) and morphine 0.1 mg . kg-1 10 minutes after laparotomy, the group M was administered morphine 0.1 + NS before induction to GA and ketamine 0.6 mg . kg-1 10 minutes after laparotomy and the group MK was administered ketamine 0.6 mg . kg-1 + morphine 0.1 mg . kg-1 i. v. before induction to GA and normal saline 10 minutes after laparotomy. GA and monitoring were performed in a standard way. Post surgery morphine consumption during first and second 24 hours was measured using patient controlled analgesia.

The morphine consumption during the first 24 hours post surgery was in MK significantly lower then in M, resp. K (22.6 ± 7 mg vs. 30.2 ± 12.1; P < 0.05, resp. 34.1 ± 12.1; P < 0.001). The morphine consumption was lower also during the second 24 hours post surgery in MK vs. M resp. K (13.3 ± 5.4 mg vs. 20.1 ± 9 mg, resp. 22.0 ± 10 mg, both P < 0.01). There were no significant differences in morphine consumption between M and K in any measured interval. There was no case of an insufficient analgesia in any group.

The combination of the pre-emptive ketamine and morphine administration causes better post-operative analgesia (measured by the morphine consumption after surgery), then when one drug is used before surgery and the other one after surgical stimulus.

Key words:
pre-emptive analgesia – postoperative analgesia – morphine – ketamine

Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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