Application Of Ketamine Combined With Tramadol In The Preemptive Analgesia For Laparoscopic Cholecystectomy

Objective: To investigate the effectiveness and the safety ofketamine combined with tramadol in the preemptive analgesia forlaparoscopic cholecystectomy and provide a convenient and practicalpathway for relieving pain after LC.Methods: Thirty of patients grading ASAI-â…¡and undergoingselective LC operation were randomly divided into 3 groups, group A, Band C, 10 cases in each one. They were treated as follows, respectively:The patients in Group A were injected 0.3 mg.kg^-1 of ketamine and 1mg·kg^-1 of tramadol (diluted to 5 ml with saline) through vein 5 minutesbefore incision and were injected saline 5 ml 5 minutes before operationending. The patients in Group B were injected with saline 5 ml 5 minutesbefore incision and with ketamine 0.3 mg·kg^-1 and tramadol 1 mg·kg^-1 5minutes before operation ending. The patients in Group C were injectedwith saline 5 ml 5 minutes before incision and 5 minutes before operationending. All of patients in three groups, practiced with general anesthesia,were monitored for the levels of blood sugar, cortisol and tumor necrosisfactor-αat the time before anesthesia(T₀), 30 minutes afterpneumoperitoneum(T₁), 0 minute after extubation (T₂) and 24 hours afteroperation(T₃), respectively, and VAS scores were recorded on the time of2.h, 4 h, 6 h, 12 h, 24 h after operation, respectively. Awake time and side effects after operation were observed and compared among the patients ofthree groups.Results1. Stress response:â‘ The level of blood sugar in three groups wereall achieved the pinnacle 30 minute after pneumoperitoneum and resumedto normal range on the whole 24 hours after operation. In comparison ingroups, There were all significant difference at T₁, T₂ time point in groupA and at T₁, T₂, T₃ time point in group B and C compared withpreoperation .In comparison among groups, there were all remarkablysignificant significance between group B, C and A at T₁, T₂, T₃ time point.â‘¡The concentration of cortisol in three groups were all achieved thepinnacle 30 min after pneumoperitoneum. The concentration of cortisol ingroup A was maintained fundamentally steady duringsurrounding-operation, no remarkable fluctuation. However, there wereobvious step-up on the concentrations of cortisol in group B and C at T₁,T₂, T₃ time point compared with preoperation. In comparison amonggroups, there were significant or remarkably significant difference amonggroup B, C and A at T₁, T₂, T₃ time point.â‘¢There was no differenceabout the level of TNF in each time point within three groups whetheramong groups or in groups, showing that preemptive analgesia canimprove the time and the degree of stress responces after operation.2. The VAS scores in each time point within 24 h after operation in group A were all less than those in group C, representing difference, andscores in each time point within 6 h after operation were all less thangroup B, representing significant difference. There was no significance inVAS scores within 6 h after operation between group B and C. It wasshowed that preemptive analgesia can transparently relieve pain afteroperation and rise whole satisfaction of patients.3. There were no significant significance in awake time and qualitybetween group A and C and in side effects after operation in three groups,showing the practicability and safety of application of ketamine 0.3mg·kg^-1 combined with tramadol 1 mg.kg^-1 in the preemptive analgesiafor LC.Conclusion1. The application of ketamine 0.3 mg·kg^-1 combined with tramadol1 mg·kg^-1 in the preemptive analgesia for LC can transparently relievepain after operation and rise whole satisfaction of patients.2. Preemptive analgesia for LC can improve the time and the degreeof stress response after operation and do not rise side effects.