Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid-dependent patients.

Autor: Nielsen RV; Department of Neuroanesthesiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Glostrup, Denmark., Fomsgaard JS; Department of Neuroanesthesiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Glostrup, Denmark., Nikolajsen L; Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark., Dahl JB; Department of Anesthesiology, Bispebjerg University Hospital, Copenhagen, Denmark., Mathiesen O; Department of Anesthesiology, Zealand University Hospital Koege, Koege, Denmark.
Jazyk: angličtina
Zdroj: European journal of pain (London, England) [Eur J Pain] 2019 Mar; Vol. 23 (3), pp. 455-460. Date of Electronic Publication: 2018 Oct 14.
DOI: 10.1002/ejp.1317
Abstrakt: Background: We aimed to explore the effect of intraoperative S-ketamine on analgesic consumption and pain one year after spine surgery in chronic opioid-dependent patients undergoing spinal fusion surgery.
Methods: Single-centre, randomized, blinded trial of 147 patients.
Intervention: Perioperative S-ketamine bolus 0.5 mg/kg followed by S-ketamine 0.25 mg kg -1  hr -1 infusion or placebo.
Main Outcomes: Analgesic use, pain (visual analogue scale 0-100 mm [VAS]) and labour market attachment one year after surgery assessed by written questionnaires.
Results: Response rate was 67%. One year after surgery, the daily use of oral morphine equivalents was lower in the ketamine group versus the placebo group: 0 (0-20) mg versus 20 (0-62) mg, (p = 0.02), and fewer patients had a daily use of any analgesics in the ketamine group versus placebo group, 42% (95% CI 23-61) versus 74% (95% CI 58-87), (p = 0.04). Mobilization pain was lower in the ketamine group compared to the placebo group: Median difference 17 mm (95% CI -30 to -3), (p = 0.02). Pain at rest was lower in the ketamine group compared to the placebo group with median difference: 13 mm (95% CI -23 to -3), (p = 0.01). Further, labour market attachment was better in the ketamine group, (p = 0.02).
Conclusion: Intraoperative ketamine may reduce analgesic use, pain, and improve labour market attachment one year after spine surgery in a chronic opioid-dependent population.
Significance: This randomized clinical trial shows that intraoperative ketamine may reduce opioid use and pain and improve labour market attachment one year after spine surgery in an opioid-dependent population.
(© 2018 European Pain Federation - EFIC®.)
Databáze: MEDLINE
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