Low-Dose Ketamine Infusions for Postoperative Pain in Opioid-Tolerant Orthopaedic Spine Patients

Farrington, Michele; Hanson, A.; Laffoon, Trudy; Cullen, Laura

doi:10.1016/j.jopan.2015.03.005

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…5 Other areas within orthopedic surgery have also reported difficulties in managing opioid-tolerant patients. 6,7 Standard treatment regimens often do not provide adequate pain control for opioid-tolerant patients. 8 Compared with opioid-naive patients, opioid-tolerant patients report higher pain scores and require higher doses of opioids to manage pain after surgery.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Management of Non–“Opioid-Naive” Patients Undergoing Hand and Upper-Extremity Surgery

Wong

Goyal

2019

Hand (New York, N,Y.)

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Background: Patients with prior opioid use are often difficult to manage postoperatively. We examined potential strategies for managing these patients: (1) prescribing a different opioid; and (2) encouraging the use of nonopioid analgesics over opioids. Methods: A pain control program was implemented at an outpatient hand and upper-extremity center. Patients were recruited before (n = 305) and after (n = 225) implementation. Seventy of them were taking opioids prior to surgery. Information about pain control satisfaction and opioid use was collected. The Fisher exact test was used to compare categorical variables with small expected frequencies. Wilcoxon rank sum test was used to compare nonnormally distributed continuous variables. Results: Opioid users used 28.8 ± 25.6 opioid pills; nonopioid users used 14.5 ± 21.5 pills. Furthermore, 41.4% of opioid users sought more pills after surgery compared with 14.0% among nonopioid users. The pain control program was more effective in reducing opioid consumption and waste and increasing nonopioid consumption for nonopioid users than for opioid users. Prior opioid users who were prescribed a different opioid after surgery used 24.6 ± 22.0 opioid pills. Patients prescribed the same opioid used 37.9 ± 30.8 pills. Conclusions: Patients taking opioids prior to hand and upper-extremity surgery use more opioid pills, seek more pills after surgery, and are less satisfied with their pain control than their nonopioid user counterparts. Furthermore, the comprehensive pain plan was less effective in this patient population. Prescribing a different opioid reduced medication requirements for these patients, but additional strategies are needed to address postoperative pain management.

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