Initial experience with ketamine-based analgesia in patients undergoing robotic radical cystectomy and diversion

Abstract

Introduction: We instituted a ketamine-predominant analgesic regimen in the peri-and postoperative periods to limit the effects of narcotic analgesia on bowel function in patients undergoing radical cystectomy. The primary end points of interest were time to return of bowel function, time to discharge, and efficacy of the analgesic regimen. Methods: We performed a retrospective chart review of patients undergoing robotic-assisted laparoscopic cystectomy (RARC) with urinary diversion by a single surgeon at our institution from January 1, 2011 to June 30, 2012. Patients receiving the opioid-minimizing ketamine protocol were compared to a cohort of patients undergoing RARC with an opioid-predominant analgesic regimen. Results: In total, 15 patients (Group A) were included in the ketamine-predominant regimen and 25 patients (Group B) in the opioid-predominant control group. Three patients (19%) in Group A discontinued the protocol due to ketamine side effects. The mean time to bowel movement and length of stay in Group A versus Group B was 3 versus 6 days (p < 0.001), and 4 versus 8 days, respectively (p < 0.001). Group A patients received an average of 13.0 mg of morphine versus 97.5 mg in Group B (p < 0.001). Conclusions:Patients who received our ketamine pain control regimen had a shorter time to return of bowel function and length of hospitalization after RARC. Our study has its limitations as a retrospective, single surgeon, single institution study and the nonrandomization of patients. Notwithstanding these limitations, this study was not designed to show inferiority of one approach, but instead to show that our protocol is safe and efficacious, warranting further study in a prospective fashion.

Suppression of mICAT in Mouse Small Intestinal Myocytes by General Anaesthetic Ketamine and its Recovery by TRPC4 Agonist (-)-englerin A

“…a profound paralytic ileus developing in patients treated with ketamine for severe bronchospasm (Amoroso and Best, 1989). Another more recent study showed that when ketamine-predominant, opioid minimizing perioperative pain control protocol was used the median time to return of bowel function was 3 days, as opposed to 6 days with an opioid-predominant analgesic regimen (Jacobsohn et al, 2015). Randomized controlled trials showed the incidence of ileus associated with intravenous ketamine use for postoperative analgesia in patients undergoing laparoscopic cholecystectomy (Ye et al, 2017).…”