Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

Spreng, U.J.; Dahl, Vegard; Ræder, Johan

doi:10.1016/j.sjpain.2010.01.001

Cited by 17 publications

(27 citation statements)

References 335 publications

(471 reference statements)

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“… 18 With the theoretical basis of preventing central sensitisation, S(+)-ketamine has been widely used as an adjuvant drug. 19 However, some key questions remained unanswered: What are the optimal dose, route of administration and drug compatibility recommended in clinical? How effective would S(+)-ketamine be when widely used in the Chinese population?…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, to the best of our knowledge, the SAFE-SK-A study is the first and largest-scale trial exploring the optimal approach for perioperative pain management in China to date. Previous evidence of S(+)-ketamine in the management of postoperative pain are only derived from several small scale randomised trials, as reported by Mendola et al (66 patients), 22 Spreng et al (77 patients) 19 and Ithnin et al (90 patients). 23 Here, we plan to recruit 12 000 patients and stratified according to the operation type, aiming to provide large-scale, randomised evidence for the analgesic effect and safety of S(+)-ketamine.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative intravenous S(+)-ketamine for acute postoperative pain in adults: study protocol for a multicentre, randomised, open-label, positive-controlled, pragmatic clinical trial (SAFE-SK-A trial)

et al. 2021

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Introduction Postoperative pain remains incompletely controlled for decades. Recently, multimodal analgesia is emerging as a potential approach in the management of postoperative pain. Therein, S(+)-ketamine is appealing as an adjuvant drug in multimodal analgesia due to its unique pharmacological advantages. This pragmatic clinical trial (SAFE-SK-A trial) is designed to investigate the analgesic effect and safety of S(+)-ketamine for acute postoperative pain in adults and explore the optimal strategy of perioperative intravenous S(+)-ketamine in a real-world setting. Methods and analysis This multicentre, randomised, open-label, positive-controlled, pragmatic clinical trial (SAFE-SK-A study) is planned to conduct in 80 centres from China and recruit a total of 12 000 adult participants undergoing a surgical procedure under general anaesthesia. Patient recruitment started in June 2021 and will end in June 2022. Participants will be randomised in a ratio of 2:1 to either receive perioperative intravenous S(+)-ketamine plus conventional anaesthesia or conventional anaesthesia only. Given the pragmatic nature of the study, no specific restriction as to the administration dosage, route, time, synergistic regimen or basic analgesics. Primary endpoints are the area under the broken line of Numerical Rating Scale (NRS) scores for pain intensity and the total opioid consumption within 48 hours postoperative. Secondary endpoints are postoperative NRS scores, the anaesthesia recovery time, time of first rescue analgesia, the incidence of rescue analgesia, the incidence of postoperative delirium, patient questionnaire for effect, changes from baseline in cognitive function and anxiety and depression, as well as the adverse events and pharmacoeconomic outcomes. The general linear model will be used for the primary endpoint, and appropriate methods will be used for the secondary endpoints. Ethics and dissemination This trial has been approved by the local Institutional Review Board (S2021-026-02) and conducted following the Declaration of Helsinki. Results of this trial will be publicly disclosed and published in scientific journals. Trial registration number NCT04837170; Pre-results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative intravenous S(+)-ketamine for acute postoperative pain in adults: study protocol for a multicentre, randomised, open-label, positive-controlled, pragmatic clinical trial (SAFE-SK-A trial)

et al. 2021

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“…Thirteen new studies (n = 1,283 participants) [14][15][16][17][18][19][20][21][22][23][24][25][26][27] evaluated ketamine or (S)-ketamine (total, 27 studies; n = 2,757). Nine of 27 studies reported prevalence of any pain at 3 months, 16,20,22,26,29,37,[39][40][41] 16 studies at 6 months, [14][15][16][17]22,[24][25][26]30,[33][34][35][36][37]40,41 and five studies at 12 months. [14][15][16]28,30 Prevalence of any pain at 3 months ranged from 5.6 to 72.2% (mean, 35.0%) in the placebo arm and 5.6 to 83.3% (mean, 31.5%) in the ketamine arm.…”

Section: Ketaminementioning

confidence: 99%

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

Carley¹,

Chaparro²,

Choinière³

et al. 2021

Anesthesiology

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Background Chronic postsurgical pain can severely impair patient health and quality of life. This systematic review update evaluated the effectiveness of systemic drugs to prevent chronic postsurgical pain. Methods The authors included double-blind, placebo-controlled, randomized controlled trials including adults that evaluated perioperative systemic drugs. Studies that evaluated same drug(s) administered similarly were pooled. The primary outcome was the proportion reporting any pain at 3 or more months postsurgery. Results The authors identified 70 new studies and 40 from 2013. Most evaluated ketamine, pregabalin, gabapentin, IV lidocaine, nonsteroidal anti-inflammatory drugs, and corticosteroids. Some meta-analyses showed statistically significant—but of unclear clinical relevance—reductions in chronic postsurgical pain prevalence after treatment with pregabalin, IV lidocaine, and nonsteroidal anti-inflammatory drugs. Meta-analyses with more than three studies and more than 500 participants showed no effect of ketamine on prevalence of any pain at 6 months when administered for 24 h or less (risk ratio, 0.62 [95% CI, 0.36 to 1.07]; prevalence, 0 to 88% ketamine; 0 to 94% placebo) or more than 24 h (risk ratio, 0.91 [95% CI, 0.74 to 1.12]; 6 to 71% ketamine; 5 to 78% placebo), no effect of pregabalin on prevalence of any pain at 3 months (risk ratio, 0.88 [95% CI, 0.70 to 1.10]; 4 to 88% pregabalin; 3 to 80% placebo) or 6 months (risk ratio, 0.78 [95% CI, 0.47 to 1.28]; 6 to 68% pregabalin; 4 to 69% placebo) when administered more than 24 h, and an effect of pregabalin on prevalence of moderate/severe pain at 3 months when administered more than 24 h (risk ratio, 0.47 [95% CI, 0.33 to 0.68]; 0 to 20% pregabalin; 4 to 34% placebo). However, the results should be interpreted with caution given small study sizes, variable surgical types, dosages, timing and method of outcome measurements in relation to the acute pain trajectory in question, and preoperative pain status. Conclusions Despite agreement that chronic postsurgical pain is an important topic, extremely little progress has been made since 2013, likely due to study designs being insufficient to address the complexities of this multifactorial problem. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…All potentially relevant records were available as full‐text articles (n = 19). Of these, 12 were further excluded (not adequately controlled [n = 3], inadequate intervention [n = 3], no outcome of interest [n = 3], no general anaesthesia [n = 3]) . Seven reports comparing the administration of intraoperative ketamine with no intervention (no drug or placebo) were included .…”

Section: Resultsmentioning

confidence: 99%

Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta‐analysis

Hovaguimian

Tschopp

Beck‐Schimmer

et al. 2018

Acta Anaesthesiol Scand

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Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

Cited by 17 publications

References 335 publications

Perioperative intravenous S(+)-ketamine for acute postoperative pain in adults: study protocol for a multicentre, randomised, open-label, positive-controlled, pragmatic clinical trial (SAFE-SK-A trial)

Perioperative intravenous S(+)-ketamine for acute postoperative pain in adults: study protocol for a multicentre, randomised, open-label, positive-controlled, pragmatic clinical trial (SAFE-SK-A trial)

Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis

Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta‐analysis

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