Epidural ketamine in the dromedary camel.

By London Spine
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Epidural ketamine in the dromedary camel.

Vet Anaesth Analg. 2012 May;39(3):291-5

Authors: Azari O, Molaei MM, Emadi L, Sakhaee E, Esmaeili M

Abstract
OBJECTIVE: To evaluate the clinical and physiological effects of epidural injection of ketamine in camels.
STUDY DESIGN: Randomized prospective study.
ANIMALS: Ten healthy immature male dromedary camels.
METHODS: Ketamine was administered epidurally at doses of 1 and 2 mg kg(-1) (five animals in each treatment). The drug was injected into the first intercoccygeal epidural space. Anti-nociception, sedation, ataxia, and effect on cardiopulmonary, rectal temperature and some selected haematological parameters were recorded at different intervals before (baseline) and after the drug administration. Data were analyzed by anova or U Mann-Whitney tests, as relevant and significance was taken as p < 0.05.
RESULTS: Epidural ketamine at the 2 mg kg(-1) dose produced complete anti-nociception in the tail, anus and perineum, whilst the 1 mg kg(-1) dose produced complete anti-nociception only in the tail. Epidural ketamine resulted in mild to moderate sedation at the 1 mg kg(-1) dose and deep sedation at the 2 mg kg(-1) dose. Ataxia was observed in all test subjects and was severe, resulting in recumbency, in the 2 mg kg(-1) group. Respiratory rate and rectal temperature did not change significantly after injection of either treatment. Following epidural injection of 2 mg kg(-1) of ketamine, heart rate increased significantly from the pre-injection baseline of 55 ± 2 to 76 ± 4 (mean ± SD) beats minute(-1), but after the lower dose changes were not significant. The only significant changes in measured haematologic parameters were decreases in total erythrocyte count at 45 minutes and total leukocyte count from 45-75 minutes, in the 2 mg kg(-1) group.
CONCLUSION: Epidural ketamine injection was associated with caudal anti-nociception, sedation and ataxia in the dromedary camels; the intensity and duration of which was dose dependent.
CLINICAL RELEVANCE: Neither of the doses of epidural ketamine injection in our study was applicable for standing surgical procedures in dromedary camels.

PMID: 22420374 [PubMed – indexed for MEDLINE]

Effect of addition of epidural ketamine to steroid in lumbar radiculitis: one-year follow-up.

By London Spine
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Effect of addition of epidural ketamine to steroid in lumbar radiculitis: one-year follow-up.

Pain Physician. 2011 Sep-Oct;14(5):475-81

Authors: Amr YM

Abstract
BACKGROUND: Treating sciatica with epidural steroid injection has been a common practice worldwide. N-methyl-D-aspartate (NMDA) receptors are an important component of pain pathways.
OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of epidurally administered NMDA receptor antagonists (ketamine) for the treatment of chronic low back pain secondary to radiculopathy and its effect on patients’ quality of life.
STUDY DESIGN: Randomized, double blind controlled trial.
SETTING: Hospital outpatient setting.
METHODS: Two hundred participants aged 25 to 50 years old with a diagnosis of lumbar radiculopathic pain secondary to disc herniation were randomized into 2 equal groups. Group I received 80 mg of triamcinolone (2 mL) and 0.25% bupivacaine (3 mL) plus 30 mg (3 mL) of preservative free ketamine. Group II received 80 mg of triamcinolone (2 mL) and 0.25% bupivacaine (3 mL) plus 3 mL of 0.9% saline. Pain scores were obtained before injection, immediately after injection, one week, one month, 3 months, 6 months , 9 months and one year post injection. The Oswestry Low Back Pain Disability Questionnaire was used at baseline and at one month, 3, 6, 9, and 12 months after injection for assessment of quality of life. Patients were asked to report any side effects, particularly those related to ketamine, including nausea, vomiting, visual or auditory hallucinations, and delirium.
RESULTS: Immediately after injection there was no statistically significant difference between Group I and II regarding pain scale scores. After one week of injection, pain relief was significantly better in Group I compared to Group II and then at all evaluation times. The Oswestry Low Back Pain Disability Questionnaire score decreased significantly (P < 0.05) from 72 (range 62- 83) and 70 (range 57- 82) to 8 (range 2 – 12) and 17 (range 9 – 27) at one month; 6 (range 4 – 12) and 18 (range 14 – 22) at 3 months; 12 (range 9 – 16) and 28 (range 22 – 34) at 6 months; 17 (range 9 – 24) and 31 (range 21 – 35) at 9 months; and 17 (range 8 – 22) and 33 (range 20 – 37) at 12 months in the groups, respectively. Six patients in the ketamine group showed short-lasting delusions lasting for 45 ± 12 minutes after injection.
LIMITATIONS: The limitations include a lack of placebo control.
CONCLUSION: Epidurally administrated ketamine seems to be a safe and useful adjunct to epidural corticosteroid therapy in chronic lumbar radicular pain.

PMID: 21927052 [PubMed – indexed for MEDLINE]