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: | Vesa P. Kontinen, Kreu Maisniemi, Klaus T. Olkkola, Jukka Mulo, Taru Virtanen, Marko A. Peltoniemi, Teijo I. Saari, Venla Soini, Urmas Savolainen, Antti Liukas, Elina C. V. Brinck, P. Tarkkila, Sanna Mäkelä, Juho Rantakokko, Ville-Veikko Hynninen |
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| Přispěvatelé: | HUS Perioperative, Intensive Care and Pain Medicine, Anestesiologian yksikkö, Department of Diagnostics and Therapeutics, HUS Musculoskeletal and Plastic Surgery, Clinicum, Vesa Kontinen / Principal Investigator, Department of Pharmacology, Medicum, Helsinki University Hospital Area |
| Rok vydání: | 2021 |
| Předmět: |
Male
PHARMACOKINETICS Nervous System Procedures 0302 clinical medicine 030202 anesthesiology Outcome Assessment Health Care Medicine and Health Sciences Pain Measurement RISK Analgesics Pain Postoperative Multidisciplinary Lumbar Vertebrae Pharmaceutics ADDING KETAMINE Drugs Middle Aged 3. Good health Analgesics Opioid Research Design Anesthesia Medicine Female Ketamine Oxycodone Research Article medicine.drug Adult Clinical Research Design Science Analgesic Pain Surgical and Invasive Medical Procedures Research and Analysis Methods Placebo Drug Administration Schedule MORPHINE 03 medical and health sciences AGE Signs and Symptoms Lumbar Double-Blind Method Drug Therapy medicine Humans Pain Management COMBINATION Adverse effect Aged Pharmacology ACUTE POSTOPERATIVE PAIN Dose-Response Relationship Drug business.industry Lumbosacral Region Analgesia Patient-Controlled PHARMACODYNAMICS 3126 Surgery anesthesiology intensive care radiology Opioids Clinical trial Spinal Fusion Opioid Pharmacodynamics Morphine Adverse Events Clinical Medicine Analgesia business 030217 neurology & neurosurgery |
| Zdroj: | PLoS ONE PLoS ONE, Vol 16, Iss 6, p e0252626 (2021) |
| DOI: | 10.1101/2021.01.22.21250352 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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