Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia

Abstract

Background:Use of opioids for perioperative analgesia is associated with sedation, respiratory depression and postoperative nausea and vomiting. N-methyl-D-aspartate receptor antagonist such as ketamine has both analgesic and antihyperalgesic properties. We studied the effect of intraoperative infusion of low-dose ketamine on postoperative analgesia and its management with opioids.Materials and Methods:A total of 80 patients scheduled for open cholecystectomy under general anesthesia were randomly allocated into two equal groups in a randomized double-blinded way. The general anesthetic technique was standardized in both groups. Group K patients (n = 40) received bolus of ketamine 0.2 mg/kg intravenously followed by an infusion of 0.1 mg/kg/h before skin incision, which was continued up to the end of surgery. Similar volume of saline was infused in Group C (n = 40). The pain score at different intervals and cumulative morphine consumption over 24 h was observed. Secondary outcomes such as hemodynamic parameters, patient satisfaction score and incidences of side effects were also recorded.Results:Intraoperative infusion of low-dose ketamine resulted in effective analgesia in first 6 h of the postoperative period, which was evident from reduced pain scores and reduced opioid requirements (P = 0.001). The incidence of side effects and patient satisfaction were similar in both groups.Conclusion:Intraoperative low-dose ketamine infusion provides good postoperative analgesia while reducing need of opioid analgesics, which must be considered for better management of postoperative analgesia.

Ketamine: 50 Years of Modulating the Mind

“…The use of ketamine infusions has been shown to be an opiate-sparing technique in managing post-operative pain following a variety of surgeries, including abdominal (Guillou et al, 2003; Webb et al, 2007; Zakine et al, 2008; Kaur et al, 2015), thoracic (Michelet et al, 2007; Nesher et al, 2008, 2009; Chazan et al, 2010), orthopedic (Adam et al, 2005; Kollender et al, 2008; Cha et al, 2012; Akhavanakbari et al, 2014), spinal (Kim et al, 2013) and gynecological (Sen et al, 2009; Suppa et al, 2012). However, others have not observed ketamine to have significant clinical benefits or opioid-sparing effects in postoperative pain management (Jensen et al, 2008; Sveticic et al, 2008; Reza et al, 2010; Yeom et al, 2012).…”

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…In addition to reducing acute postoperative pain and opioid consumption, the perioperative administration of gabapentin or pregabalin has been associated with a reduction in the incidence of chronic pain . Other adjuncts such as methadone, ketamine, and dexmedetomidine have been associated with opioid sparing effects during and after surgery, and may be initiated in the intraoperative period . In our study, the small group of children who received a multimodal TIVA (propofol, ketamine, dexmedetomidine, and epidural) had a significantly lower intraoperative opioid consumption, compared to those who received volatile‐opioid‐based anesthesia with an epidural (mean morphine dose equivalents; 0.5 vs 0.9, difference in mean = −0.4, 95% CI: −0.7, −0.1, P = .004).…”

“…23,24 Other adjuncts such as methadone, ketamine, and dexmedetomidine have been associated with opioid sparing effects during and after surgery, and may be initiated in the intraoperative period. 20,[25][26][27] In our study, the small group of children who received a multimodal TIVA (propofol, ketamine, dexmedetomidine, and epidural) had a significantly lower intraoperative opioid consumption, compared to those who received volatile-opioid-based anesthesia with an epidural (mean morphine dose equivalents; 0.5 vs 0.9, difference in mean = À0.4, 95% CI: À0.7, À0.1, P = .004). However, since a multimodal approach was not uniformly employed in the postoperative period, there was no reduction in opioid consumption over the entire hospitalization (mean morphine dose equivalents; 33.6 vs 24.9, difference in mean = 8.7, 95% CI: 39.1, 56.6, P = .70).…”

Opioid-free anaesthesia in three dogs

“…It is thought to provide less intense analgesia than pure-µ opioids and is often used in combination with an opioid for multimodal analgesic effects (Carstensen and Moller, 2010;Gutierrez-Blanco et al, 2015). Ketamine is a common component of OFA in people and has even been shown to reduce the development of OIH if administered prior to opioid treatment in animals (Celerier et al, 2000) and humans (Hong et al, 2011;Kaur et al, 2015). The dysphoria reported for Case 2 after premedication was believed to be secondary to ketamine administration.…”