C ombination of Ketamine with Morphine, Nalbuphine or Tramadol for postoperative pain control following radical prostatectomy

The study compares the efficacy of postoperative analgesia after the intravenous administration of opioids (nalbuphine, tramadol or morphine) in combination with ketamine in patients undergoing radical prostatectomy.Eighty eight patients scheduled for radical prostatectomy were randomly assigned in three groups. In Group A (n=31) Morphine was administered {bolus dose (BD) 0.05mg/Kg and continuous infusion (CI) at a dose [mg/24h =18-(agex0.15)]}, in Group B (n=28) Nalbuphine (BD 0.2mg/kg and CI at a rate 0.05mg/kg/h) and in Group C (n=29) Tramadol (BD 1.5mg/Kg and CI at a rate 0.15mg/Kg/h). In all groups opioids were administered in combination with ketamine (BD 10mg and CI at a rate 0.15mg/Kg/h). Infusion pumps were designed to provide 24h postoperative pain relief. In all patients, efficacy of postoperative analgesia was evaluated at 6h and 24h postoperatively. Pain intensity was assessed by Numerical Rating Scale at rest and movement. The additional analgesics and the adverse effects were also assessed 24h postoperatively. Group C showed statistical significant higher NRS pain scores at movement compared to other groups at 6h postoperatively. At 24h postoperatively, at rest, group B showed statistical significant higher pain scores compared to group A and C. Group B showed higher incidence of pruritus, bowel movement and rescue analgesics compared to groups A and C. We conclude that in patients undergoing radical prostatectomy, the combination of tramadol plus ketamine was less effective concerning postoperative pain and patients needed more rescue analgesics compared to morphine plus ketamine and nalbuphine plus ketamine groups.