Pre-emptive multimodal analgesia with tramadol and ketamine–lidocaine infusion for suppression of central sensitization in a dog model of ovariohysterectomy

• Main Authors: Kaka, Ubedullah, Rahman, Nor Alimah, Abubakar, Adamu Abdul, Goh, Yong Meng, Fakurazi, Sharida, Omar, Mohamed Ariff, Chen, Hui Cheng
• Format: Article
• Language: English
• Published: Dove Medical Press 2018
• Online Access: http://psasir.upm.edu.my/id/eprint/73596/1/Pre-emptive%20multimodal%20analgesia%20with%20tramadol%20and%20ketamine%E2%80%93lidocaine%20infusion%20for%20suppression%20of%20central%20sensitization%20in%20a%20dog%20model%20of%20ovariohysterectomy.pdf; http://psasir.upm.edu.my/id/eprint/73596/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905489/pdf/jpr-11-743.pdf

Objectives: The effects of pre-emptive infusion of ketamine-lidocaine with tramadol on the suppression of central sensitization were investigated in a dog ovariohysterectomy model. Patients and methods: Twelve dogs were randomly assigned to two groups: ketamine-lidocaine-tramadol (KLT) and tramadol (T) groups. Both groups received intravenous tramadol 4 mg/kg body weight as premedication. Immediately after induction, the KLT group received ketamine and lidocaine at 0.5 and 2 mg/kg loading dose, followed by continuous rate infusion of 50 and 100 µg/kg/min, respectively, for 2 hours. Dogs in T group received saline bolus and continuous rate infusion at equi-volume. Intraoperatively, hemodynamic responses to surgical stimulation were recorded, whereas postoperative pain was evaluated using an algometer and short form of the Glasgow composite measure pain scale. Results: Intraoperatively, hemodynamic responses to surgical stimulation were obtunded to a greater degree in KLT compared to T group. Postoperatively, the pain scores increased only for the first hour in KLT group, compared to 12 hours in T group. Mechanical thresholds at the abdomen decreased postoperatively between 12 and 60 hours in KLT group versus the entire 72 hours in T group. Thresholds at tibia and radius in both groups increased in the immediate 1 hour postoperatively, but decreased thereafter. Significant decrement of thresholds from baseline were detected in the tibia at 24, 42, and 60 hours in KLT group compared to 24-72 hours in T group, and in the radius between 36 and 48 hours in T group, but none in KLT group. Conclusion: Addition of pre-emptive ketamine-lidocaine infusion to single intravenous dose of tramadol enhanced attenuation of central sensitization and improved intra- and postoperative analgesia.