Intraoperative Ketamine may Influence Persistent Pain following Knee Arthroplasty under Combined General and Spinal Anaesthesia: A Pilot Study

Abstract

We report the findings of a randomised controlled triple-blind pilot study of intraoperative ketamine infusion combined with spinal anaesthesia on the prevalence of persisting post surgical pain following total knee arthroplasty surgery. Twelve patients were randomised to receive either ketamine or placebo in association with spinal anaesthesia for total knee arthroplasty. All patients also received general anaesthesia. More patients were pain-free at six months in the ketamine group (three of five) compared to the control group (two of seven). Perioperative data collected during the study suggested that the addition of intraoperative ketamine might also improve the quality of recovery. Although no statistical analysis was undertaken due to the small numbers, these preliminary findings suggest that the use of intraoperative systemic ketamine in association with spinal anaesthesia for the reduction of persisting post surgical pain deserves further study.

The Use of Intravenous Infusion or Single Dose of Low-Dose Ketamine for Postoperative Analgesia: A Review of the Current Literature

“…The authors reported no difference in physical therapy needed or in adverse events between groups. Perrin and Purcell [15], using an intraoperative infusion of 0.5 mg/kg + 0.24 mg/kg/h of ketamine, reported a higher improvement in pain scores in the ketamine group at 4 weeks postoperative (average improvement from preoperative ratings on the Womac Pain Scale was 5.2 points in the ketamine group compared with 1.4 in the placebo group). With the highest regimen, they assessed—0.5 mg/g/h + 0.25 mg/kg/h—De Kock et al.…”

“…The second group gathers 10 studies using pain scores as first endpoint. Finally, the third group concerns studies which did not report a primary endpoint or used endpoints aside from pain scores or opioid consumption (one was only descriptive [15], one did not report on their primary endpoint [16], three used pain scores and opioid consumption as their secondary endpoints while using as primary endpoint: time to first analgesic [17] or hyperalgesia [18,19]). For this last group, studies were included only to assess ketamine's safety, not efficacy.…”

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

“…After in-depth review of 25 papers, 15 were excluded for a variety of predetermined reasons, such as lack of suitable control group, ketamine co-administered with other analgesics, or unavailability of data extraction. Eventually, 10 papers11–18 24 25 were included in final analyses (figure 1). The characteristics of 10 included studies are presented in table 1.…”

“…The characteristics of 10 included studies are presented in table 1. Among these studies, seven11–16 25 involve intravenous administration of ketamine and three involve either intra-articular or epidural administration of ketamine 17 18 24. The methodological quality of the involved trials is shown in figures 2 and 3.…”

“…The methodological quality of the involved trials is shown in figures 2 and 3. It can be seen that most of them were of high quality according to Cochrane Collaboration’s recommended tool, and only one study25 was rated as low quality. Seven studies adopted appropriate methods to generate the random sequence, and six studies claimed that the allocation concealment was achieved by sealed envelopes.…”