Systemic Ketamine for the Improvement of Post-Operative Analgesia at the Alcohol-Dependent Patient

• pain [ Time Frame: pain ] [ Designated as safety issue: Yes ]
• the ground (dependence with alcohol) [ Time Frame: dependence with alcohol ] [ Designated as safety issue: Yes ]
• the first request analgesic [ Time Frame: the first request analgesic ] [ Designated as safety issue: Yes ]
• the tolerance and the signs psychic (syndrome of weaning...) [ Time Frame: the tolerance and the signs psychic ] [ Designated as safety issue: Yes ]
• and the satisfaction of the patient [ Time Frame: the satisfaction of the patient ] [ Designated as safety issue: Yes ]

• pain
• the ground (dependence with alcohol)
• the first request analgesic
• the tolerance and the signs psychic (syndrom of weaning...)
• and the satisfaction of the patient

The principal objective is to evaluate the analgesic effectiveness of the systemic ketamine on the control of the pain (average consumption of morphine at 48 hours) at the alcool-dependent patient, in carcinological surgery ORL. The effect coanalgesic is found for low dose of ketamine and action anti NMDA seems to have a stabilizing effect on this particular type of patient. This imbalance of the receivers, with a greater number of r-NMDA among these patients would involve it a better analgesic effectiveness and less effects dysphoric, to see an improvement on the syndrome of weaning. The secondary objectives evaluate the pain, the ground (dependence with alcohol), the first request analgesic, the tolerance and the signs psychic (syndrome of weaning...) and the satisfaction of the patient.

The principal objective is to evaluate the analgesic effectiveness of the systemic ketamine on the control of the pain (average consumption of morphine at 48 hours) at the alcool-dependent patient, in carcinological surgery ORL. The effect coanalgesic is found for low dose of ketamine and action anti NMDA seems to have a stabilizing effect on this particular type of patient. This imbalance of the receivers, with a greater number of r-NMDA among these patients would involve it a better analgesic effectiveness and less effects dysphoric, to see an improvement on the syndrome of weaning. The secondary objectives evaluate the pain, the ground (dependence with alcohol), the first request analgesic, the tolerance and the signs psychic (syndrome of weaning...) and the satisfaction of the patient.

• Alcoholic Patient
• Carcinological Surgery ORL

• Elia N, Tramèr MR. Ketamine and postoperative pain--a quantitative systematic review of randomised trials. Pain. 2005 Jan;113(1-2):61-70. Review.
• Petrakis IL, Limoncelli D, Gueorguieva R, Jatlow P, Boutros NN, Trevisan L, Gelernter J, Krystal JH. Altered NMDA glutamate receptor antagonist response in individuals with a family vulnerability to alcoholism. Am J Psychiatry. 2004 Oct;161(10):1776-82.

Inclusion Criteria:

• patient alcohol-dependent having to undergo a carcinological surgery ORL with tracheotomy or tracheostomy, ASA 1-3

Exclusion Criteria:

• refusal of the patient
• counter-indications with the treatments,
• urgency
• the specific clinical context (final neoplasy, reanimation)
• the treatments for chronic pain containing morphinic