Intraoperative Ketamine Reduces Perioperative Opiate Consumption in Opiate-dependent Patients with Chronic Back Pain Undergoing Back Surgery

Loftus, Randy W.; Yeager, Mark P.; Clark, Jeffrey L.; Brown, Jeremiah R.; Abdu, William A.; Sengupta, Dilip K.; Beach, Michael L.

doi:10.1097/aln.0b013e3181e90914

Cited by 389 publications

(209 citation statements)

References 36 publications

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“…Ketamine also acts as a cardiac depressant in dogs after pharmacological blockade of the autonomic nervous system [11]. In opiatedependent patients, ketamine was not associated with significant changes in heart rate [12] and a similar lack of effect was observed in patients injected with 10 μg/kg) [13]. In isolated human muscle strips, a low dose of ketamine (73 μM) increased contractility and relaxation while at a higher dose (730 μM) a direct inotropic action was observed [14].…”

Section: Introductionmentioning

confidence: 83%

l-Carnitine rescues ketamine-induced attenuated heart rate and MAPK (ERK) activity in zebrafish embryos

Kanungo

Cuevas

Ali

et al. 2012

Reproductive Toxicology

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Ketamine, an antagonist of the N-methyl-D-aspartate (NMDA)-type glutamate receptors, is a pediatric anesthetic. Ketamine has been shown to be neurotoxic and cardiotoxic in mammals. Here, we show that after 2 h of exposure, 5 mM ketamine significantly reduced heart rate in 26 h old zebrafish embryos. In 52 h old embryos, 1 mM ketamine was effective after 2 h and 0.5 mM ketamine at 20 h of exposure. Ketamine also induced significant reductions in activated MAPK (ERK) levels. Treatment of the embryos with the ERK inhibitor, PD 98059, also significantly reduced heart rate whereas the p38/SAPK inhibitor, SB203580, was ineffective. Ketamine is known to inhibit lipolysis and a decrease of ATP content in the heart. Co-treatment with Lcarnitine that enhances fatty acid metabolism effectively rescued ketamine-induced attenuated heart rate and ERK activity. These findings demonstrate that L-carnitine counteracts ketamine's negative effects on heart rate and ERK activity in zebrafish embryos.

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Section: Introductionmentioning

confidence: 83%

l-Carnitine rescues ketamine-induced attenuated heart rate and MAPK (ERK) activity in zebrafish embryos

Kanungo

Cuevas

Ali

et al. 2012

Reproductive Toxicology

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“…This includes multilevel instrumentation which is often associated with severe pain and consumption of large amounts of opioids thereby hindering postoperative mobilization and rehabilitation [3,4]. Also, patients undergoing major spine surgery often suffer from pre-operative chronic pain, further challenging postoperative pain treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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“…chronic pain patients) (32). However, a complete understanding of the mechanisms of action and pharmacology are missing.…”

Section: Discussionmentioning

confidence: 99%

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Halaszynski

Dai

Huang

2018

Turk J Anaesth Reanim

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Objective: Inferior and limited analgesic options/techniques during living donor hepatectomy surgery can result in pain and risks of morbidity, opioid-related adverse events (AEs), predisposition to the development of chronic pain and concerns of potential narcotic abuse. Traditional analgesia uses unimodal intravenous opioids that can cause significant side effects. Ketamine provides analgesia and may be opioid sparing, but use in living-donor hepatectomy has not been studied. Methods: Following human investigation committee approval and informed written consent, 47 liver donor patients over a 5-year period scheduled for surgery were categorized into one of three groups: 24 patients received no ketamine (Group 1), 9 received only intraoperative ketamine (Group 2) and 14 patients received intraoperative plus postoperative ketamine (Group 3). Subjects had access to opioid patient-controlled analgesia (PCA). Chart reviews (including operating room and intensive care unit) were collected and analysed for morphine consumption, pain-intensity scores, opioid-sparing effects, AEs of analgesics and for evidence of ketamine side effects on donor hepatectomy patients. Results: There were no differences in patient demographics. Living donor hepatectomy patients receiving intraoperative ketamine that was continued postoperatively consumed fewer morphine-equivalents and had lower median pain scores than subjects from the other two groups. Ileus occurred in those not receiving ketamine, pruritus was lowest in Group 3, and there was no evidence or reports of ketamine-associated AEs. Conclusion: Perioperative ketamine for donor hepatectomy patients could safely provide improved analgesia and be opioid sparing when compared to PCA opioids alone, and there is no evidence of ketamine-related AEs at the dose and delivery methods described here during partial liver donation surgery. Keywords: Living-donor liver transplantation, ketamine, perioperative analgesia Amaç: Canlı donörlü hepatektomi ameliyatı sırasında uygulanan inferior ve sınırlı analjezi seçenekleri/teknikleri ağrıya ve morbidite riskine, opioide bağlı yan etkilere, kronik ağrı gelişimi eğilimine ve potansiyel narkotik bağımlılığına neden olabilirler. Geleneksel analjezi uygulamasında, önemli yan etkilere neden olabilen unimodal intravenöz opioidler kullanılmaktadır. Ketamin analjezi sağlar ve opioid tüketimini azaltabilir. Ancak canlı donörlü hepatektomide kullanımı hakkında henüz çalışma yapılmamıştır. Yöntemler: İnsan araştırmaları etik kurulu onayı ve yazılı bilgilendirilmiş hasta onam formu alındıktan sonra, 5 yıllık bir süreçte ameliyat olması planlanan 47 canlı donör hastası 3 gruba ayrıldı. 24 hastaya hiç ketamin verilmedi (Grup 1); 9 hastaya sadece intraoperatif ketamin verildi (Grup 2); ve 14 hastaya intraoperatif ve postoperatif ketamine uygulandı (Grup 3). Denekler hasta kontrollü opioid analjezisi kullandılar. Hastaların tıbbi kayıtları toplandı (ameliyathane ve yoğun bakım ünitesinden) ve morfin kullanımı, ağrı-yoğunluk skorları, opioid tüketiminin azaltıc...

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Intraoperative Ketamine Reduces Perioperative Opiate Consumption in Opiate-dependent Patients with Chronic Back Pain Undergoing Back Surgery

Cited by 389 publications

References 36 publications

l-Carnitine rescues ketamine-induced attenuated heart rate and MAPK (ERK) activity in zebrafish embryos

l-Carnitine rescues ketamine-induced attenuated heart rate and MAPK (ERK) activity in zebrafish embryos

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

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