The Early and Delayed Analgesic Effects of Ketamine After Total Hip Arthroplasty: A Prospective, Randomized, Controlled, Double-Blind Study

Abstract

Ketamine had a morphine-sparing effect after THA, even when morphine was combined with multimodal systemic analgesia. It also facilitated rehabilitation at 1 mo and decreased postoperative chronic pain up to 6 mo after surgery.

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

“…58 Ketamine may be especially useful as part of a multimodal analgesic regimen in postsurgical patients with high opioid requirements or opioid-refractory pain. As NMDA receptors are involved in the development of pathological pain states, such as hyperalgesia, ketamine has also been shown to decrease chronic postsurgical pain and opioid consumption after total hip arthroplasty (ketamine 0.5 mgÁkg -1 iv before incision and a 24-hr infusion of 2 lgÁkg -1 Ámin -1 ) 59 and even in opioid-dependent patients undergoing lumbar spine surgery. 59,60 Importantly, the specific use of ketamine for patients with chronic pain, whether perioperatively or otherwise, is currently off-label and not well-studied.…”

“…As NMDA receptors are involved in the development of pathological pain states, such as hyperalgesia, ketamine has also been shown to decrease chronic postsurgical pain and opioid consumption after total hip arthroplasty (ketamine 0.5 mgÁkg -1 iv before incision and a 24-hr infusion of 2 lgÁkg -1 Ámin -1 ) 59 and even in opioid-dependent patients undergoing lumbar spine surgery. 59,60 Importantly, the specific use of ketamine for patients with chronic pain, whether perioperatively or otherwise, is currently off-label and not well-studied. Ketamine is U.S. Food and Drug Administration (FDA) approved as a supplement for lowpotency agents (e.g., nitrous oxide) as well as for diagnostic and surgical procedures that do not require skeletal muscle relaxation for induction of anesthesia before the administration of other general anesthetic agents.…”

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

“…Ketamine (a non-competitive NMDA receptor antagonist) is believed to reduce pain and analgesic consumption through the prevention of NMDA-mediated sensitization of spinal cord dorsal horn neurons [46]. Fourteen trials comparing ketamine to placebo for CPSP have been previously identified [11], of which 12 were used in the Chaparro et al [11] systematic review [47][48][49][50][51][52][53][54].The majority of trials identified used pre-incisional loading doses of ketamine ranging from 0.15 to 1 mg/kg, plus an intraoperative infusion. A total cumulative dose of less than 1 mg/kg was reached in 6/14 studies, 4/14 studies administered a cumulative dose of ketamine between 1 and 2 mg/kg, and 4/14 administered a dose greater than 2 mg/ kg [11].…”

Assessment and management of chronic pain in patients with stable total hip arthroplasty

“…In addition, Ketamine also showed a morphine-sparing effect after THA, even when morphine was combined with multimodal systemic analgesia. Furthermore, Ketamine also facilitated rehabilitation and reduced persistent postoperative chronic pain up to six months after surgery [14].…”