Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

Schmid, Roger; Sandler, Alan N.; Katz, Joel

doi:10.1016/s0304-3959(99)00044-5

Cited by 492 publications

(321 citation statements)

References 94 publications

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“…[9][10][11][12][13][14] These discrepancies may be due to the large interstudy variability in surgical procedures, patient population, dose of ketamine administered, timing of administration, and study design. 15,16 In studies that fail to demonstrate a preventive effect of a low-dose ketamine on postoperative pain, the question of whether a lack of efficacy on central sensitization is linked to insufficient pre-or postoperative blockade remains unresolved. Pre-emptive analgesia requires that a preoperative analgesic intervention reduce pain or analgesic consumption to a greater extent than the identical intervention administered after surgery.…”

Section: Methodsmentioning

confidence: 99%

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lebrun¹,

Elstraete²,

Sandefo³

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: The aim of this study was to assess the effect of pre-vs postincisional low-dose iv ketamine on postoperative pain in outpatients scheduled for oral surgery under general anesthesia. Methods:Eighty-four patients were randomly assigned to receive intravenously saline before and after surgery in Group 1, ketamine 300 µg·kg -1 iv before and saline after surgery in Group 2, saline before and ketamine 300 µg·kg -1 iv after surgery in Group 3. Postoperative analgesia consisted of iv proparacetamol and ketoprofen. Rescue analgesia consisted of nalbuphine 200 µg·kg -1 iv. Analgesia at home consisted of oral ketoprofen, and acetaminophen with codeine as rescue analgesia. A telephone interview was conducted on the first and second postoperative days.Results: There were no significant differences between groups with respect to pain scores, the number of patients requiring nalbuphine in the postanesthesia care unit (PACU), (36.7%, 38.7%, and 39.5% for Groups 1, 2, and 3 respectively), or nalbuphine consumption in the PACU (66.5 µg·kg -1 ± 16.8, 75.9 µg·kg -1 ± 17.5, 66.7 µg·kg -1 ± 21.6 for Groups 1, 2, and 3 respectively). The number of rescue analgesic tablets taken at home, and time to first request for rescue analgesia, sedation scores, or side-effects were similar amongst groups. No patient required nalbuphine in the ambulatory care unit. Conclusions: There was no benefit to pre-emptive administration of ketamine 300 µg·kg -1 iv whether administered pre-or postoperatively. (36,7 %, 38,7 %, et 39,5 % respectivement pour les Groupes 1, 2 et 3), la consommation de nalbuphine (66,5 µg·kg -1 ± 16,8, 75,9 µg·kg -1 ± 17,5, 66,7 µg·kg -1 ± 21,6 respectivement pour les Groupes 1, 2 et 3), le nombre de comprimés de secours à domicile : 6 (2,13), 7 (2,20), et 7 (1,12) Objectif

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Section: Methodsmentioning

confidence: 99%

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lebrun¹,

Elstraete²,

Sandefo³

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…However, use of these inhibitors is limited because of the numerous side effects resulting from antagonizing NMDA receptors in the CNS (Enarson, Hays, & Woodroffe, 1999; Rabben et al., 1999; Schmid et al, 1999). Several reports have shown that NMDA receptors are present in both CNS and in the peripheral nerves (Carlton, 2001; Carlton & Coggeshall, 1999; Coggeshall & Carlton, 1998).…”

Section: Discussionmentioning

confidence: 99%

Lentiviral vector‐encoded microRNA‐based shRNA‐mediated gene knockdown of N‐methyl‐D‐aspartate receptors in skin reduces pain

Liu¹,

Cheng

Hung

et al. 2016

Brain and Behavior

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Background and Purpose RNA polymerase II promoters that drive the expression of rationally designed primary microRNA‐based shRNA, for example, shRNAmir, can produce more potent gene knockdown than RNA polymerase III promoters. Antagonists of peripheral N methyl‐D‐aspartate (NMDA) receptors that do not interfere with central glutamate processing would prevent the development of adverse central nervous system effects. Thus, in this study, we examined the effects of gene silencing and antinociception on formalin‐ and Complete Freund's adjuvant (CFA)‐induced pain in rats by subcutaneously injecting a lentiviral vector encoding a shRNAmir that targets the NR1 subunit of the NMDA receptor.MethodsRats received intradermal injections of different doses of NR1 shRNAmir at different time points before injection of formalin. Pain behavior was assessed by monitoring the paw flinch response, paw withdrawal threshold, and thermal withdrawal latency. We then analyzed NR1 messenger RNA and protein expression in skin and the L5 dorsal root ganglion (DRG).ResultsWe found that intradermal injection of 1, 5, and 10 μg of shRNAmir significantly inhibited flinch responses (p < .05). Administration of 5 μg of shRNAmir resulted in the attenuation of CFA‐induced mechanical allodynia, but did not affect the time spent on the rotarod. Real‐time polymerase chain reaction and western blotting revealed that NR1 mRNA and protein levels were significantly lower in all NR1 shRNAmir1 groups than in controls (p < .05). There was a significant reduction in the percentage of NR1‐ and pERK‐positive neurons in the DRG ipsilateral to shRNAmir treated paws (p < .05). The effect of antinociception and inhibition of NR1 expression by NR1 shRNAmir was evident on day 3 and persisted for 7 days after injection of 5 μg of vector.ConclusionPeripheral administration of the vector‐encoded NR1 shRNAmir is a promising therapy for persistent inflammatory pain.

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“…In humans, the peripheral administration of ketamine enhanced the local anesthetic and analgesic actions of bupivacaine used for infiltration [9]. Schmid et al [14] reviewed the use and efficacy of low-dose ketamine in the management of acute postoperative pain and the evidence suggested that low-dose ketamine may play an important role in postoperative pain management when used as an adjunct to local anaesthetics, opioids, or other analgesic agents.…”

Section: Discussionmentioning

confidence: 99%

“…Recently ketamine has been used in oral and maxillofacial surgical practice as well [14,[32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

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Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

Cited by 492 publications

References 94 publications

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lentiviral vector‐encoded microRNA‐based shRNA‐mediated gene knockdown of N‐methyl‐D‐aspartate receptors in skin reduces pain

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

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