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Anesthesiology 2006; 105:111–9 © 2006 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc.

Low-dose Intravenous Ketamine Potentiates Epidural Analgesia after Thoracotomy
Manzo Suzuki, M.D.,* Syuji Haraguti, M.D.,† Kikuzo Sugimoto, M.D., Ph.D.,‡ Takehiko Kikutani, M.D.,* Yoichi Shimada, M.D., Ph.D.,§ Atsuhiro Sakamoto, M.D., Ph.D.

Background: Ketamine potentiates intravenous or epidural morphine analgesia. The authors hypothesized that very-lowdose ketamine infusion reduces acute and long-term postthoracotomy pain. Methods: Forty-nine patients scheduled to undergo open thoracotomy were randomly assigned to receive one of two anesthesia regimens: continuous epidural infusion of
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We enrolled 50 patients who were scheduled to undergo open thoracotomy in this double-blind, placebo-controlled, randomized, two-group parallel study. The length of incision was approximately 15 cm. Surgical manipulation had to include cutting a rib and reconstructing it using a rib reconstruction pin, and cutting and reconstruction of one or more muscles such as the latissimus dorsi muscle. Exclusion criteria were morbid obesity (body mass index 30 kg/m2); allergy to local anesthetics, opioids, or ketamine; diabetes; psychiatric disorder; and age over 80 yr. Patients were assigned to 111

* Instructor, § Associate Professor, Department of Anesthesiology, † Assistant Professor, Department of Surgery, Second Hospital Nippon Medical School, Kanagawa, Japan. ‡ Assistant Professor, Department of Anesthesiology, Second Hospital Nippon Medical School. Current position: Chief in Anesthesiology, Higashitotuka Memorial Hospital, Kanagawa, Japan. Professor and Chair, Department of Anesthesiology, Nippon Medical School. Received from the Department of Anesthesiology, Second Hospital, Nippon Medical School, Kanagawa, Japan. Submitted for publication October 24, 2005. Accepted for publication March 24, 2006. Supported by Hisamitsu Pharmaceutical Company, Tokyo, Japan. Address correspondence to Dr. Suzuki:

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