Apport de l’administration de kétamine à l’induction et en entretien anesthésique dans la prévention de la douleur postopératoireEssai clinique en oncologie

Introduction. - Carcinologic breast surgery is responsible of intermediary postoperative pain and needs 30% additional morphine. Now, morphine administration generates adverse effects. Publications about morphine saving effect of ketalar as antagonist of R-NMDA, administrated in perioperative increase are discussed. Objective. - To evaluate the morphine saving effect of ketalar in carcinologic breast surgery. Patients and method. - This phase III randomized and double-blind study includes 208 patients during 14 months. Surgery consisted in mastectomy with or without axillary lymph node dissection or lumpectomy with axillary lymph node dissection. Group K received ketalar at induction until the end of surgery. Group P (placebo) received physiologic serum in the same condition. During the postoperative first 48 h, morphine's consumption and EN are measured. Results. - No significant difference between two groups was observed. The EN evaluation and morphine consumption remained the same in the two groups. Our results did not find any benefit with use of ketamine between axillary lymph node dissection and no axillary lymph node dissection group. Conclusion. - Ketalar adjunction in our analgesic protocol did not induce significant morphine saving in carcinologic breast surgery. (C) 2008 Publie par Elsevier Masson SAS.