Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial

Schug, Stephan A.; Peyton, Philip J

doi:10.1177/2049463717736076

Cited by 17 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Research study outcomes are unpredictable, but can be mitigated by larger multi‐centred trials with the financial resources to follow‐up patients over 12 months. The ROCKet trial is now underway in Australia and Hong Kong, and it aims to recruit 4,884 patients to a ketamine/placebo randomized controlled trial (Schug & Peyon, ).…”

Section: Discussionmentioning

confidence: 99%

Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain

Chumbley

Thompson

Swatman

et al. 2019

European Journal of Pain

View full text Add to dashboard Cite

Introduction Pain which persists after thoracotomy is well recognized, and activation of the N‐methyl‐d‐aspartate (NMDA) receptor could be a contributing factor. This study sought to establish whether ketamine given peri‐operatively could reduce persistent post‐surgical pain. Trial design Double‐blind, randomized, placebo‐controlled trial comparing low‐dose intravenous ketamine and saline placebo. Methods Seventy patients undergoing thoracotomy were randomized to receive either intravenous ketamine (0.1 mg kg−1 hr−1) or saline placebo for 96 hr, starting 10 min prior to surgery. A bolus dose of 0.1 mg/kg of ketamine/placebo was given prior to starting the infusion. Post‐operative analgesia consisted of either an epidural infusion or patient‐controlled analgesia (PCA), +/− a paravertebral infusion of local anaesthetic. Pain scores and opioid consumption were collected at 24 and 48 hr after surgery. Patients completed numeric pain scores (NPS), modified Brief Pain Inventory (BPI), the short form Leeds Assessment of Neuropathic Symptoms and Signs (S‐Lanss) at baseline, 6 weeks, 3, 6 and 12 months after surgery. Results There were no significant differences in post‐operative pain, except the ketamine group reported less pain at rest 48 hr after surgery (p = 0.03). The ketamine group requested significantly less morphine via PCA in the first 24 hr (p = 0.03). There were no differences in pain measures or opioid consumption at 6 weeks, 3, 6 or 12 months. Patients in the ketamine group were more lightheaded (p = 0.02) and experienced more vivid dreams (p = 0.001). Conclusions Ketamine reduced opioid consumption compared to placebo after surgery, but we were unable to detect any differences in persistent post‐surgical pain between the groups. Significance This study adds to the growing body of evidence advocating the use of ketamine to reduce opioid consumption. No previous studies of peri‐operative ketamine have followed patients for a year after thoracotomy. This study found no reduction in persistent post‐surgical pain.

show abstract

Section: Discussionmentioning

confidence: 99%

Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain

Chumbley

Thompson

Swatman

et al. 2019

European Journal of Pain

View full text Add to dashboard Cite

show abstract

“…The goal of identifying an 'intervention of choice' for prevention of PPP in specific clinical settings has remained elusive because the effect size of single interventions is typically small, in the order of RR = 0.3 or less. The pilot study upon which the ROCKet trial of the efficacy of perioperative ketamine for preventing PPP (Schug & Peyton, 2017) estimated an enrollment target of 4884 participants at a cost of AU$4,823,395.…”

Section: 4)mentioning

confidence: 99%

“…There is a need for better designed, large-scale, high-quality studies with adequate power to detect treatment effects of pharmacologic interventions on chronic pain outcomes 3 or more months after surgery…'. A large Phase 3/4 trial of ketamine is currently in progress (Schug & Peyton, 2017).…”

Section: Introductionmentioning

confidence: 99%

Preventing persistent postsurgical pain: A systematic review and component network meta‐analysis

Allen

Walker

Premji

et al. 2022

European Journal of Pain

View full text Add to dashboard Cite

Background and objectives: Evidence for perioperative methods to prevent persistent postsurgical pain (PPP) is uncertain, in part because few treatments have been directly compared. Here we have used component network meta-analysis (cNMA) to incorporate both direct and indirect evidence in the evaluation of the efficacy and tolerability of pharmacological and neural block treatments. Databases and data treatment:We searched the Cochrane Central Registry of Controlled Trials, Embase, MEDLINE, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry up to January 2021 for randomized, double-masked, controlled trials that reported the prevalence of PPP. We assessed trial quality with the Cochrane risk of bias tool (RoB 2.0). We analysed the results with frequentist cNMA models. The primary outcome was the relative risk (RR) of PPP. We assessed efficacy in relation to a clinically important effect size of RR = 0.9, which is a 10% improvement with treatment. Results:The analysis included 107 trials (13,553 participants) of 13 treatments.The effects of complex interventions were the multiplicative effects of their components. Compared with placebo, serotonin-norepinephrine reuptake inhibitors (SNRIs), neural block alone, or in combination with NMDA receptor blockers or gabapentanoids were effective. Treatments with benefit in the immediate postoperative period predicted a reduced risk of PPP.

show abstract

“…Thus, there is a possibility of over-evaluating the effects of the treatment, and it is necessary to be cautious when discussing the preventive effects of ketamine for CPSP. Currently, a university in Melbourne, Australia, is performing a large-scale randomized controlled trial (RCT) (the ROCKet trial) study concerning the preventive effects of ketamine for CPSP [ 35 ]. Although there is controversy concerning pregabalin and gabapentin, the most prescribed drugs for neuropathic pain, some meta-analyses report that they are effective for the prevention of CPSP [ 36 ].…”

Section: Reviewmentioning

confidence: 99%

Pain Management of Acute and Chronic Postoperative Pain

Ishida¹,

Okada²,

Kobayashi³

et al. 2022

Cureus

View full text Add to dashboard Cite

Inadequate management of acute postoperative pain is associated with effects related to both physiological and psychological function. Postoperative pain increases the risk of perioperative complications, so postoperative pain should be prevented. Postoperative pain management by sufficient analgesia is important while considering the use of various kinds of analgesics. Insufficient management of postoperative pain may lead to chronic postsurgical pain (CPSP). It is suggested that CPSP is dependent not only upon biological factors but also upon psychological factors, including the type of surgery, age, physical health, mental health, and preoperative pain. As CPSP is a severe complication that may prolong hospitalization and interferes with activities of daily living (ADL) and quality of life (QoL), its prevention of development is paramount. Therefore, in order to prevent the onset of CPSP, it is necessary to craft analgesic management to prevent CPSP during the perioperative period.

show abstract

Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial

Cited by 17 publications

References 19 publications

Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain

Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain

Preventing persistent postsurgical pain: A systematic review and component network meta‐analysis

Pain Management of Acute and Chronic Postoperative Pain

Contact Info

Product

Resources

About