What Is the Role of Ketamine in Postoperative Pain Management?

Maranhao, Bruno; Gregory, Stephen H.

doi:10.1053/j.jvca.2019.11.020

Cited by 3 publications

(1 citation statement)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, its applicability in terms of dosing and management guidelines need to be studied further. 23 There are a few limitations of this study-We did not follow up the patients to evaluate whether chronic pain was reduced with the small doses of Ketamine used in the study. As we have not included opioid-tolerant patients or cancer patients on chronic pain medications as a part of this study, we cannot comment on the efficacy of such low-dose Ketamine for post-operative pain management in such populations.…”

Section: Discussionmentioning

confidence: 99%

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Sardeshpande,

Deshmukh

2023

IJCA

View full text Add to dashboard Cite

The use of Ketamine, an NMDA receptor antagonist, in sub-anesthetic doses for analgesia is increasingly being administered in inpatient settings with acute pain service guidance and in outpatient settings under a variety of models. At sub-anesthetic doses, ketamine possesses centrally mediated analgesic properties with minimal effects on consciousness and cognition.In this study we have compared the efficacy of IV low-dose Ketamine as an adjunct to conventional systemic analgesia to examine preventive effect on post-operative pain and opioid consumption in patients undergoing laparotomies.The study was carried out on 50 patients, 25 patients received a pre-incisional IV bolus of 0.15 mg/kg of Ketamine,10 mins before the incision followed by IV infusion of 2mcg/kg/min continued for 24 hours postoperatively in addition to systemic analgesia (Group K)and 25 Patients received IV bolus of Normal Saline 10 min before the incision, followed by an IV infusion of normal saline (Group C) till 24 hours post-op and systemic analgesia alone. Saline bolus and infusion were given at equivalent volume/rate of the study group. The analgesic efficacy was judged by NRS (Numeric Pain Rating Scale), Time to first rescue analgesia (TFA) and Total opioid consumption (Tramadol in mg) in 24 hours. Ketamine related side effects were also recorded.Patients in the Ketamine group had significantly lower Mean total opioid consumption (88.04 ± 29.07 mg vs. 210 ± 23.93 mg)and Numerical pain Rating Scale (NRS) (3.13 +0.34 vs. 4.44+ 0.77). Time to first rescue analgesia was significantly delayed in Ketamine group as compared to Control group (20.65 ± 9.2 mins vs. 5.4 ± 5.38 mins). Ramsay Sedation scores (RSS) were significantly higher in the Ketamine group (2.4 +0.76vs. 1.52 +0.51)in the immediate post-operative period. There were no demonstrable side-effects related to Ketamine in Group K.Pre-emptive IV low-dose Ketamine is an effective adjunct to systemic analgesia in abdominal surgeries as it significantly prolongs the time to first rescue analgesia (TFA), reduces mean total analgesic requirement and lowers pain scores (NRS) in the post-operative period with negligible side effects.

show abstract

Section: Discussionmentioning

confidence: 99%

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Sardeshpande,

Deshmukh

2023

IJCA

View full text Add to dashboard Cite

show abstract

Intravenous Methadone versus Intrathecal Morphine as Part of an Enhanced Recovery After Cardiac Surgery Protocol on Postoperative Pain and Outcomes: A Retrospective Cohort Study

LaColla,

Nanez,

Frabitore

et al. 2024

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Ketamine as part of multi-modal analgesia may reduce opioid requirements following cardiac surgery: a retrospective observational cohort study

Hall,

Chung,

Khilkin

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Postoperative pain control in cardiac surgery is often managed with opioid medications. Insufficient analgesia can result in complications including splinting, pneumonia, and delay of appropriate rehabilitation. Surgeries involving the highly innervated thoracic wall, such as cardiac surgery, make pain control particularly challenging. Given the risk for addiction and the many adverse effect of opioids in the postoperative patient including sedation, respiratory depression, delirium, and decrease gastrointestinal motility, multimodal non-opioid pain regimens are the preferential treatment regimen. Recently, there is increasing evidence that low dose Ketamine, an N-methyl-D-Aspartate (NMDA) receptor antagonist, is a safe and effective for analgesia in postoperative patients. Methods: This study is a single center, retrospective, observational, cohort study involving adult patients admitted for cardiac surgery at a single center during a one year period comparing those who received a single dose of ketamine, 0.3 mg/kg over 30 minutes with those who did not. A total of 120 patient charts were reviewed, of which 96 met inclusion criteria. 32 patients had received ketamine and 64 had not. Charts were reviewed for opioid and other pain medication requirements as well as secondary outcomes including hospital length of stay, ICU length of stay, in-hospital and 30-day mortality, 30-day readmission, and rates of delirium, emergence reactions, and need for additional respiratory support. Results: The group who received ketamine required d 28.8 MME less opioid during admission (90.1 mg vs 118.9 mg, p = 0.167), and was prescribed an average of 15.8 MME less on discharge (p < 0.001). The groups differed in respect to operation type and controlling for this failed to achieve significance in needs during admission (p = 0.215), but remained significant on discharge (p = 0.02). The ketamine group also required less acetaminophen but more gabapentin. There was no difference in hospital or ICU length of stay, mortality, or readmission. 15 instances of respiratory escalation occurred, all included in the ketamine group, but all of these patients received ketamine following this decompensation, none preceding it. Conclusions: Ketamine may be a reasonable choice for postoperative cardiac surgery analgesia and may reduce the need for opioids on discharge, and possibly during admission.

show abstract

What Is the Role of Ketamine in Postoperative Pain Management?

Cited by 3 publications

References 9 publications

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Intravenous Methadone versus Intrathecal Morphine as Part of an Enhanced Recovery After Cardiac Surgery Protocol on Postoperative Pain and Outcomes: A Retrospective Cohort Study

Ketamine as part of multi-modal analgesia may reduce opioid requirements following cardiac surgery: a retrospective observational cohort study

Contact Info

Product

Resources

About