Low-dose intravenous ketamine for postcardiac surgery pain: Effect on opioid consumption and the incidence of chronic pain

Ann Card Anaesth. 2017 Oct-Dec;20(4):395-398. doi: 10.4103/aca.ACA_54_17.

Abstract

Background: Recent meta-analyses have concluded that low-dose intravenous ketamine infusions (LDKIs) during the postoperative period may help to decrease acute and chronic postoperative pain after major surgery.

Aims: This study aims to evaluate the level of pain at least 3 months after surgery for patients treated with a postoperative LDKI versus patients who were not treated with a postoperative LDKI.

Methods: Administrative and Ethics Board approval were obtained for this study. We performed a retrospective chart review for all patients receiving LDKI, and equal number of age-, sex-, and surgery-matched patients who did not receive LDKI. Low-dose ketamine was prepared using 100 mg of ketamine in 100 ml of normal saline and run between 50 and 200 mcg/kg/h.

Results: We reviewed 115 patients with LDKI and 115 without LDKI. The average age was 63.1 years, 73% of the patients were men and sex was evenly distributed between LDKI and non-LDKI. The average duration of the ketamine infusions was 26.8 h with the average dose being 169.9 mg. At an average of 9 months after surgery, 42% of the ketamine group and 38% of the nonketamine group stated that they had had pain on discharge. Of these patients, 30% of the ketamine group and 26% of the nonketamine group still had pain at the time of the phone call. Women in both groups had more acute and chronic pain than men.

Conclusion: These results show that LDKI does not promote a decrease in long-term postoperative pain.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / therapeutic use*
  • Anesthetics, Dissociative / administration & dosage
  • Anesthetics, Dissociative / therapeutic use*
  • Cardiac Surgical Procedures / adverse effects*
  • Case-Control Studies
  • Chronic Pain / drug therapy
  • Chronic Pain / epidemiology
  • Female
  • Humans
  • Incidence
  • Infusions, Intravenous
  • Ketamine / administration & dosage
  • Ketamine / therapeutic use*
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / epidemiology
  • Prevalence
  • Retrospective Studies

Substances

  • Analgesics, Opioid
  • Anesthetics, Dissociative
  • Ketamine