S(+)-Ketamine as an Analgesic Adjunct Reduces Opioid Consumption After Cardiac Surgery

Abstract

There are no studies evaluating S(+)-ketamine for pain management after sternotomy. In this prospective, randomized, double-blind, placebo-controlled clinical trial, we evaluated the efficacy and feasibility of S(+)-ketamine as an adjunctive analgesic after cardiac surgery. Ninety patients scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either a 75 microg/kg bolus of S(+)-ketamine followed by a continuous infusion of 1.25 microg . kg(-1) . min(-1) for 48 h (n = 44) or placebo (normal saline bolus and infusion) (n = 46). From the time of tracheal extubation, patients could access an opioid (oxycodone) via a patient-controlled analgesia device, and the cumulative oxycodone doses were measured over 48 h. Pain was evaluated on a visual analog scale three times daily. The quality of recovery, patient satisfaction with pain management, and adverse effects were recorded. The cumulative oxycodone consumption during the first 48 postoperative hours was less in the S(+)-ketamine group (103 +/- 44 mg) than in the placebo group (125 +/- 45 mg; mean difference, 22 mg; 95% confidence interval for the difference, 3-40 mg; P = 0.023). Pain scores did not differ between the groups at rest (P = 0.17) or during a deep breath (P = 0.23). Patient satisfaction was superior in S(+)-ketamine-treated patients: 26 (60%) of 44 in the S(+)-ketamine group compared with 16 (35%) of 46 in the placebo group were very satisfied with the analgesic management (P = 0.032). Nausea and vomiting were the most common adverse events, with similar frequencies in both groups. Four patients in the S(+)-ketamine group developed transient hallucinations during the infusion, versus none in the placebo group. In conclusion, small-dose S(+)-ketamine decreased opioid consumption in CABG patients during the first 48 h after surgery.

The effect of low-dose intravenous ketamine on continuous intercostal analgesia following thoracotomy

“…[11,12] Lahtinen et al have documented that a continuous intravenous infusion of ketamine 1.25 µg/kg/min potentiates opioid patient controlled analgesia following cardiac surgery. [14] Based on the dose regimens in these studies, we assessed the effect of intravenous low-dose ketamine 0.05 mg/kg/h on continuous intercostal nerves block following thoracotomy. Our data indicated that low-dose intravenous ketamine did not decrease pain scores and rescue morphine requirement in patients having continuous intercostal analgesia.…”

“…Previous reports did not find an increased sedation in patients receiving intravenous low-dose ketamine following surgery. [12,14,16,17] Only Ilkjaer et al reported a significantly higher level of sedation in patients given intravenous ketamine in combination with epidural bupivacaine after renal surgery. [15] Ketamine psychomimetic side effects include blurred vision, vertigo, hallucination, and nightmares.…”

Avaliação do efeito preemptivo da s(+)-cetamina por via peridural para histerectomia: concentrações plasmáticas de interleucinas

“…One study demonstrated an evident preemptive effect with epidural analgesia, reducing pain intensity and consumption of complementary analgesics, thus increasing the time to request the first complementation 19 . Other authors also obtained reduction of intensity of postoperative pain by administering ketamine before and during surgery 20,21 . Nevertheless, they did not obtain an improved analgesic effect with ketamine when administered before incision or after surgery 22,23 .…”

“…Ketamine is an antagonist of NMDA receptors and the S(+)-ketamine isomer is more powerful than the racemic drug and causes less adverse effects [5][6][7][8][9][10] . Although many studies have used ketamine, its preemptive effect is controversial [11][12][13] . There is not much information available about administration of epidural ketamine and attenuation of inflammatory response.…”

Sedierung und Analgesie auf der Intensivstation: Physiologie und Anwendung

“…Hier sind aber nicht die μ-Rezeptoren betroff en, womit es nicht zu einer Atemdepression kommt. Vor allem in niedriger Dosierung zeigt S-Ketamin einen opioidsparenden Eff ekt [36,37]. Zusätzlich kann eine mög-liche opioid-induzierte Hyperalgesie durch Einsatz von Ketamin reduziert werden [38].…”