S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.

Autor:	Brinck ECV; Division of Anaesthesiology, Intensive Care and Pain Medicine, Department of Anaesthesiology, Töölö Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Virtanen T; Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland., Mäkelä S; Division of Perioperative Services, Intensive Care Medicine and Pain Management; Turku University Hospital, Turku, Finland., Soini V; Division of the musculoskeletal system at Turku University Hospital, Department of Orthopaedics, Turku University Hospital, University of Turku, Turku, Finland., Hynninen VV; Division of Perioperative Services, Intensive Care Medicine and Pain Management; Turku University Hospital, Turku, Finland., Mulo J; Division of Perioperative Services, Intensive Care Medicine and Pain Management; Turku University Hospital, Turku, Finland., Savolainen U; Division of Perioperative Services, Intensive Care Medicine and Pain Management; Turku University Hospital, Turku, Finland., Rantakokko J; Division of the musculoskeletal system at Turku University Hospital, Department of Orthopaedics, Turku University Hospital, University of Turku, Turku, Finland., Maisniemi K; Division of Anaesthesiology, Intensive Care and Pain Medicine, Department of Anaesthesiology, Töölö Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Liukas A; Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland., Olkkola KT; Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Kontinen V; Division of Anaesthesiology, Intensive Care and Pain Medicine, Department of Anaesthesiology, Jorvi Hospital, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland., Tarkkila P; Division of Anaesthesiology, Intensive Care and Pain Medicine, Department of Anaesthesiology, Töölö Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Peltoniemi M; Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland., Saari TI; Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.; Division of Perioperative Services, Intensive Care Medicine and Pain Management; Turku University Hospital, Turku, Finland.
Jazyk:	angličtina
Zdroj:	PloS one [PLoS One] 2021 Jun 07; Vol. 16 (6), pp. e0252626. Date of Electronic Publication: 2021 Jun 07 (Print Publication: 2021).
DOI:	10.1371/journal.pone.0252626
Abstrakt:	Background: Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown. Methods: We randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml-1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery. Results: Of the 100 patients analyzed, patients receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml-1 (74.7 mg) or 0.25 mg ml-1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: -20.6 mg; 95% confidence interval [CI]: -41 to -0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013-0.32, P = 0.033). The occurrence of adverse events was similar among the groups. Conclusions: Oxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects. Competing Interests: The authors have declared that no competing interests exist.
Databáze:	MEDLINE
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