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Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomised double-blind study.

Scoliosis repair is a major orthopaedic surgery associated with severe post‐operative pain. Ketamine and magnesium have an established efficacy as morphine‐sparing agents. Our purpose was to evaluate the morphine‐sparing effect of both magnesium and ketamine given simultaneously compared with ketamine alone during scoliosis surgery.

Genotyping Test with Clinical Factors: Better Management of Acute Postoperative Pain?

Individualization of acute postoperative pain treatment on an evidence-based decision process is a major health concern. The aim of this study is to investigate the influence of genetic and non-genetic factors on the variability of response to morphine in acute postoperative pain. A group of nighty-five patients undergoing major surgery were included prospectively. At 24 h, a logistic regression model was carried out to determine the factors associated with morphine doses given by a Patient Controlled Analgesia device. The dose of morphine was associated with age (p = 0.011), patient weight (p = 0.025) and the duration of operation (p = 0.030). This dose decreased with patient’s age and duration of operation and increased with patient’s weight. OPRM1 and ABCB1 polymorphisms were significantly associated with administered dose of morphine (p = 0.038 and 0.012 respectively). Patients with at least one G allele for c.118A>G OPRM1 polymorphism (AG/GG) needed 4 times the dose of morphine of AA patients. Additionally, patients with ABCB1 CT and CC genotypes for c.3435C>T polymorphism were 5.6 to 7.1 times more prone to receive higher dose of morphine than TT patients. Our preliminary results support the evidence that OPRM1/ABCB1 genotypes along with age, weight and duration of operation have an impact on morphine consumption for acute postoperative pain treatment.

Opioid drugs: what is next for Lebanon?

Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countries have developed new regulations and policies for a better availability and accessibility of these drugs. Lebanon is not too far from these advanced strategies. The Ministry of Health and specifically the Narcotic Department have adjusted regulations related to opioid prescriptions and have registered many new opioid drugs in 2012 for a better pain-free life for our patients. However, there is still a lot to do in this field.

Ketamin und Magnesium zur Verminderung postoperativer Schmerzen

Eingriffe zur Korrektur einer Skoliose sind mit starken intra- und postoperativen Schmerzen verbunden. Zur Verminderung des postoperativen Opioidbedarfs werden bereits intraoperativ Antagonisten der N-Methyl-D-Aspartat-Rezeptoren (NMDA-Rezeptoren) eingesetzt, die auch die Entwicklung einer moglichen Remifentanil-induzierten Hyperalgesie verhindern sollen. Zu den verwendeten Substanzen gehoren Ketamin und Magnesium, die an unterschiedlichen Stellen des Rezeptors angreifen und in der Kombination daher moglicherweise Vorteile gegenuber der Einzeladministration zeigen. Eine Gruppe aus Beirut hat das nun untersucht.