Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects☆

Nesher, Nahum; Serovian, Irena; Marouani, Nissim; Chazan, Shoshana; Weinbroum, Avi A.

doi:10.1016/j.phrs.2008.06.003

Cited by 80 publications

(75 citation statements)

References 28 publications

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“…In a large trial performed after various types of orthopedic surgery, it was reported that the co-administration of ketamine and morphine (ratio 1 : 1, lockout 8 min) reduced neither postoperative pain nor postoperative PCA consumption [5]. However, after thoracic surgery, the co-administration of morphine and ketamine (bolus contained >1 mg of morphine and 5 mg ketamine) provided better analgesia through PCA than did morphine alone (bolus 1.5 mg), although observed clinical differences were small [6]. Furthermore, Atangana et al [7] demonstrated that, after thoracic surgery in nonelderly patients (average age 54 years), the co-administration of morphine and ketamine (ratio 1 : 1, lockout 5 min) resulted in a lower pain score and lower morphine consumption through PCA than morphine alone.…”

Section: Discussionmentioning

confidence: 99%

Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

Suzuki

2009

Current Opinion in Anaesthesiology

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The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.

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Section: Discussionmentioning

confidence: 99%

Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

Suzuki

2009

Current Opinion in Anaesthesiology

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“…The use of ketamine infusions has been shown to be an opiate-sparing technique in managing post-operative pain following a variety of surgeries, including abdominal (Guillou et al, 2003; Webb et al, 2007; Zakine et al, 2008; Kaur et al, 2015), thoracic (Michelet et al, 2007; Nesher et al, 2008, 2009; Chazan et al, 2010), orthopedic (Adam et al, 2005; Kollender et al, 2008; Cha et al, 2012; Akhavanakbari et al, 2014), spinal (Kim et al, 2013) and gynecological (Sen et al, 2009; Suppa et al, 2012). However, others have not observed ketamine to have significant clinical benefits or opioid-sparing effects in postoperative pain management (Jensen et al, 2008; Sveticic et al, 2008; Reza et al, 2010; Yeom et al, 2012).…”

Section: Clinical Uses In Medicinementioning

confidence: 99%

Ketamine: 50 Years of Modulating the Mind

Vlisides

2016

Front. Hum. Neurosci.

272

212

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Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine’s effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action. Emerging evidence indicates that ketamine-mediated anesthesia may occur via disruption of corticocortical information transfer in a frontal-to-parietal (“top down”) distribution. This proposed mechanism of general anesthesia has since been demonstrated with anesthetics in other pharmacological classes as well. Ketamine remains invaluable to the fields of anesthesiology and critical care medicine, in large part due to its ability to maintain cardiorespiratory stability while providing effective sedation and analgesia. Furthermore, there may be an emerging role for ketamine in treatment of refractory depression and Post-Traumatic Stress Disorder. In this article, we review the history of ketamine, its pharmacology, putative mechanisms of action and current clinical applications.

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“…Supplementary 18,[20][21][22][25][26][27]29,30,32,34,36,40,41,44,45,50 cardiac or thoracic surgery (six trials), 19,23,35,37,38,53 orthopedic surgery (ten trials), 24,28,31,33,39,43,[47][48][49]51 and other surgery (three trials). 42,46,52 General anesthesia was used in 34 trials; one trial used PCA during and after a uterine artery embolization procedure, 29 and one used either general or regional anesthesia.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials

Wang

Johnston

Kaushal

et al. 2015

Can J Anesth/J Can Anesth

102

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Purpose To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery.Source We systematically searched six databases up to June 2, 2015 for randomized controlled trials (RCTs) comparing ketamine plus morphine/hydromorphone PCA vs morphine/hydromorphone PCA for postoperative pain in adults. Principal findings Thirty-six RCTs including 2,502 patients proved eligible, and 22 of these were at low risk of bias. The addition of ketamine to morphine/

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Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects☆

Cited by 80 publications

References 28 publications

Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

Ketamine: 50 Years of Modulating the Mind

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials

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