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October 2002 Letters & Emails Pre-emptive analgesia starts before the surgical incision and before the injection of the local analgesia (“New Ways to Contain Post-op Pain,” August, p. 24). Titrating a BIS-monitored propofol infusion to 70-75 before administering a 50-mg dissociative dose of ketamine is the critical component missing in all previous Level I studies of preemptive analgesia. Blocking the NMDA receptors with a dissociative dose of ketamine not only produces an immobile patient for the local analgesia injection but also sets the stage for genuine pre-emptive analgesia. My patients are routinely pre-oped with oral clonidine 0.2 mg and rofecoxib 50 mg 30-60 mg before induction. I have not used any opioids in my practice since December 1997 (without inflicting suffering in my patients). The key to managing post-op pain is similar to managing post-op PONV — don’t cause it in the first place! Avoid emetogenic opioids for analgesia and precede the local anesthetic injection with a 50 mg dissociative dose of ketamine under adequate propofol hypnosis. Barry L. Friedberg, MD |
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Copyright© 2001- by Barry L. Friedberg, M.D., A.M.C.,
All Rights Reserved |
