Perioperative Epidural or Intravenous Ketamine Does Not Improve the Effectiveness of Thoracic Epidural Analgesia for Acute and Chronic Pain After Thoracotomy

Tena, Beatriz; Gomar, C.; Ríos, José

doi:10.1097/ajp.0000000000000005

Cited by 40 publications

(84 citation statements)

References 58 publications

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“…One study of 185 participants, in a dose-escalation, double-blind, randomized, placebo-controlled phase III trial, where ketamine or the placebo were delivered subcutaneously over 3 to 5 d, concluded that ketamine does not have a net clinical benefit when used as an adjunct to opioids and standard co-analgesics in cancer pain [81] . A study on patients undergoing thoracotomy suggested that adding epidural or iv racemic ketamine to thoracic epidural analgesia after thoracotomy did not lead to any reduction in persistent post-surgical pain or allodynia [82] . Ketamine could be an alternative choice for pain therapy in patients with chronic pain where standard analgesics, such as opioids, or other treatments are insufficient [83] .…”

Section: Chronic Pain Managementmentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Section: Chronic Pain Managementmentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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“…Various studies have been conducted with pain treatments such as intercostal nerve block, iv-PCA, and ketamine administration (5,7,27,28). However, the optimum method to treat post-thoracotomy pain is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Post-thoracotomy pain is found in 20% to 80 % patients who have undergone thoracotomy using a chest retractor through the intercostal space (1)(2)(3)(4)(5)(6)(7)(8)(9). Epidural analgesia is known to be the gold standard for controlling pain during the perioperative period (10)(11)(12); however, its effectiveness has not been satisfactory after thoracotomy (7,13,14).…”

Section: Introductionmentioning

confidence: 99%

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

et al. 2017

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Background: The purpose of this randomized study was to compare the effects of pregabalin with epidural analgesia on early phase post-thoracotomy pain. Methods: This study was conducted on 90 adult patients who underwent thoracotomy. Patients were randomly divided into two groups, an epidural analgesia group, where 45 patients received 0.2% ropivacaine hydrochloride and fentanyl through a thoracic epidural catheter, and a pregabalin group, where 45 patients received 75 mg pregabalin orally twice daily. Both groups were also administered orally with celecoxib along with each treatment. Numerical rating scale (NRS) and sleep interference rate (SIR) were evaluated on the first day, third day, and fifth day after surgery. Anesthetic induction time, operation time, recovery time, the use of additional analgesic drugs and adverse effects were also examined. Results: NRS and SIR were significantly lower in the pregabalin group at all time points (P<0.05). The number of patients requiring additional analgesic drugs within 24 hours after surgery showed no difference between the two groups; however, the number was significantly decreased in the pregabalin group after post-operative day 1 (P<0.001). Adverse effects including pneumonia, dysuria, constipation and nausea were identified among many patients in the epidural analgesia group (P<0.05). Operation time and recovery time were the same for both groups, while the epidural analgesia group showed a significantly longer anesthetic induction time (P<0.001).Conclusions: Pregabalin is considered to be a safe and effective treatment method which is an alternative to epidural analgesia for acute post-thoracotomy pain.

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“…Systemic ketamine is reported to be effective to decrease the acute postthoracotomy pain [32–36]. Epidural ketamine is also reported to be effective in prevention of acute postthoracotomy pain and development of chronic postthoracotomy pain syndrome [37].…”

Section: Treatmentsmentioning

confidence: 99%

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

Yousefshahi

Predescu

Colizza

et al. 2016

Pain Research and Management

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Context. Postthoracotomy Ipsilateral Shoulder Pain (IPS) is a common and sometimes intractable pain syndrome. IPS is different from chest wall pain in type, origin, and treatments. Various treatments are suggested or applied for it but none of them is regarded as popular accepted effective one. Objectives. To review data and collect all present experiences about postthoracotomy IPS and its management and suggest future research directions. Methods. Search in PubMed database and additional search for specific topics and review them to retrieve relevant articles as data source in a narrative review article. Results. Even in the presence of effective epidural analgesia, ISP is a common cause of severe postthoracotomy pain. The phrenic nerve has an important role in the physiopathology of postthoracotomy ISP. Different treatments have been applied or suggested. Controlling the afferent nociceptive signals conveyed by the phrenic nerve at various levels—from peripheral branches on the diaphragm to its entrance in the cervical spine—could be of therapeutic value. Despite potential concerns about safety, intrapleural or phrenic nerve blocks are tolerated well, at least in a selected group of patient. Conclusion. Further researches could be directed on selective sensory block and motor function preservation of the phrenic nerve. However, the safety and efficacy of temporary loss of phrenic nerve function and intrapleural local anesthetics should be assessed.

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Perioperative Epidural or Intravenous Ketamine Does Not Improve the Effectiveness of Thoracic Epidural Analgesia for Acute and Chronic Pain After Thoracotomy

Abstract: Adding epidural or IV racemic ketamine to TEA after thoracotomy did not lead to any reduction in PPP or allodynia. Epidural administration produced similar plasma ketamine levels to the IV route.

Cited by 40 publications

References 58 publications

Ketamine use in current clinical practice

Ketamine use in current clinical practice

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

Postthoracotomy Ipsilateral Shoulder Pain: A Literature Review on Characteristics and Treatment

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