Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery

Abstract

BackgroundThe opioid sparing effect of low dose ketamine is influenced by bolus dose, infusion rate, duration of infusion, and differences in the intensity of postoperative pain. In this study, we investigated the opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia (PCA) using fentanyl after lumbar spinal fusion surgery, which can cause severe postoperative pain.MethodsSixty patients scheduled for elective lumbar spinal fusion surgery were randomly assigned to receive one of three study medications (K1 group: ketamine infusion of 1 µg/kg/min following bolus 0.5 mg/kg, K2 group: ketamine infusion of 2 µg/kg/min following bolus 0.5 mg/kg, Control group: saline infusion following bolus of saline). Continuous infusion of ketamine began before skin incision intraoperatively, and continued until 48 h postoperatively. For postoperative pain control, patients were administered fentanyl using IV-PCA (bolus dose 15 µg of fentanyl, lockout interval of 5 min, no basal infusion). For 48 h postoperatively, the total amount of fentanyl consumption, postoperative pain score, adverse effects and patients' satisfaction were evaluated.ResultsThe total amount of fentanyl consumption was significantly lower in the K2 group (474 µg) compared to the control group (826 µg) and the K1 group (756 µg) during the 48 h after surgery. Pain scores at rest or with movement, the incidence of adverse events and patient satisfaction were not significantly different among the groups.ConclusionsLow-dose ketamine at 2 µg/kg/min following bolus 0.5 mg/kg significantly reduced the total amount of fentanyl consumption during the 48 h after lumbar spinal fusion surgery without increasing adverse effects.

Ketamine: 50 Years of Modulating the Mind

“…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).…”

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

“…Thus, the objectives of this chart review investigation evaluated perioperative ketamine combined with traditional opioid-based pain management and examined narcotic rescue requirements in LDLT patients. If perioperative ketamine can be shown to improve postoperative pain and positively influence donor-patient analgesic experiences, then given the deficiencies of current analgesic options for this type of surgery, ketamine use during partial hepatectomy might prove beneficial and might improve patient outcomes (14).…”

“…Ketamine is a non-opioid N-methyl-D-aspartate receptor antagonist and effective adjunct to opioids for improving postoperative analgesia following moderate-to-severe pain-inducing surgery (14,28). Ketamine is also associated with opioid tolerance reversal, and no medication interactions have been reported with its use (29).…”

Intravenous Ketamine Alleviates Pain in a Rheumatoid Arthritis Patient With Comorbid Fibromyalgia

“…Ketamine appears to possess unique immunomodulatory and analgesic properties that effectively attenuate inflammation and reduce pain without the use of opioid/NSAID analgesics -which have become a worldwide epidemic leading to addiction, overdose, and death [15]. Moreover, our own clinical experience and published clinical studies by others [16] have found that ketamine can be an opioid-sparing option that can be used as a tool to reduce and, in some cases, discontinue chronic opioid use.…”