Ketamine Infusion for Postoperative Pain Management in Patients Undergoing Knee Arthroplasty: A Prospective Randomized Single-Center Study



如何引用文章

全文:

详细

BACKGROUND: Ketamine is an NMDA receptor antagonist with potent analgesic properties and is widely used as part of multimodal postoperative analgesia. This study aims to evaluate its efficacy and safety for pain management following total knee arthroplasty, with particular attention to the risk of neuropsychiatric side effects.

AIM: To assess the efficacy and safety of ketamine infusion for postoperative analgesia in patients undergoing knee arthroplasty.

METHODS: A prospective, randomized, controlled trial was conducted involving 68 patients undergoing knee arthroplasty. Patients were randomly assigned to two groups: Ketamine group: Received postoperative ketamine infusion. Control group: Received standard postoperative analgesia. Primary endpoints included pain intensity (Numerical Rating Scale, NRS), opioid consumption, and incidence of adverse effects (nausea, vomiting, neuropsychiatric side effects).

RESULTS: Ketamine administration resulted in significant pain reduction within the first 10 hours postoperatively (p=0.03) and a decrease in morphine consumption (p=0.0002) compared to the control group. However, the incidence of mild to moderate neuropsychiatric adverse effects was higher in the ketamine group (32.35% vs. 0%, p=0.0001, Fisher’s exact test). The incidence of severe neuropsychiatric adverse effects was comparable between groups (2.94% in both). The percentage of patients with insufficient analgesia was identical in both groups (5.9%).

CONCLUSION: Ketamine infusion is an effective postoperative analgesic strategy, significantly reducing opioid consumption. However, it is associated with a higher incidence of neuropsychiatric side effects (hallucinations, anxiety, disorientation). Optimizing dosing regimens may mitigate these adverse effects, reinforcing ketamine as a valuable component of multimodal analgesia.

全文:

受限制的访问

作者简介

Ivan Shcheparev

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Email: is22@list.ru
ORCID iD: 0000-0002-0432-135X

anesthesiologist-resuscitation

俄罗斯联邦, Moscow, Russia

Boris Teplykh

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Email: batru@mail.ru
ORCID iD: 0000-0002-1784-9540

anesthesiologist-resuscitation

俄罗斯联邦, Moscow, Russia

Zhanna Fedotova

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

编辑信件的主要联系方式.
Email: Breyn3012@yandex.ru
ORCID iD: 0009-0008-3253-7351

anesthesiologist-resuscitation

俄罗斯联邦, Moscow, Russia

参考

  1. Mao J. Opioid-induced hyperalgesia. Pain Clinical Updates. 2002;10(2):1–4.
  2. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–161.
  3. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104(3):570–587. doi: 10.1097/00000542-200603000-00025
  4. Richebé P, Rivat C, Laulin JP, Célérier E, Simonnet G. Ketamine improves the management of exaggerated postoperative pain observed in perioperative fentanyl-treated rats. Anesthesiology. 2005;102(2):356–363. doi: 10.1097/00000542-200502000-00028
  5. Porter SB, McClain RL, Howe BL, et al. Perioperative Ketamine for Acute Postoperative Analgesia: The Mayo Clinic—Florida Experience. Journal of PeriAnesthesia Nursing. 2015;30(3):189–195. doi: 10.1016/j.jopan.2015.01.010
  6. Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management. Regional Anesthesia and Pain Medicine. 2018;43(5):456–466. doi: 10.1097/AAP.0000000000000806
  7. Loftus RW, Yeager MP, Clark JA, et al. Intraoperative ketamine reduces perioperative opioid consumption in opioid-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–646. doi: 10.1097/ALN.0b013e3181e90914
  8. Niesters M, Martini C, Dahan A. Ketamine for chronic pain: risks and benefits. British Journal of Clinical Pharmacology. 2014;77(2):357–367. doi: 10.1111/bcp.12094
  9. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews. 2015;(7) doi: 10.1002/14651858.cd004603.pub2
  10. Michelet D, Gaudillière JP, Brasher C, et al. Ketamine for chronic pain after surgery in adults: A systematic review and meta-analysis. European Journal of Pain. 2018;22(5):798–811. doi: 10.1002/ejp.1161
  11. Brinck EC, Tiippana E, Heesen M, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Acta Anaesthesiologica Scandinavica. 2018;62(9):1185–1201. doi: 10.1002/14651858.cd012033.pub4
  12. Kozhanova AV, Plotnikov GP. Treatment of acute postoperative pain in patients undergoing open abdominal aortic repair (current state of the problem). Regional Anesthesia and Acute Pain Management. 2022;16(1):45–58. doi: 10.17816/RA106746 EDN: GSXLOP
  13. Ovechkin AM. Ketamine and postoperative pain or a new viewpoint on old agent (analytical review). Regional Anesthesia and Acute Pain Management. 2010;4(1):5–12. doi: 10.17816/RA36053
  14. Sytov AV, Shin AR, Kudryavtsev FA, Grishenkin IYu, Tachieva GB. Ketamine in postoperative pain relief. Literature review, application experience. Pallium: palliative and hospice care. 2021;4(13):38–45. EDN: MKLTYY
  15. Bazylev VV, Shcheglova KT, Chuprov MP, Magilevets AI. Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):361–370. doi: 10.17816/psaic1267 EDN: NSTDVB
  16. Shindyapina NV, Marshalov DV, Shifman EM, Kuligin AV. Low-dose ketamine as an adjuvant for postoperative pain control in postpartum women with low pain threshold: a randomized controlled trial. Annals of Critical Care. 2024;3:27–37. doi: 10.21320/1818-474X-2024-3-27-37 EDN: EUAZUJ
  17. Shindyapina NV, Marshalov DV, Shifman EM, Kuligin AV. Clinical effects of low-dose intravenous ketamine in obstetrics: a systematic review. Annals of Critical Care. 2020;2:104–121. doi: 10.21320/1818-474X-2020-2-104-121
  18. Shindyapina NV, Shifman EM, Marshalov DV, Kuligin AV. Clinical effect of low-dose ketamine in early postoperative period after caesarean section (meta-analysis). Russian Journal of Anesthesiology and Reanimatology. 2021;2:19–35. doi: 10.17116/anaesthesiology202102119 EDN: YQDNRC
  19. Efremenko IV, Ovechkin AM, Krasnoselskiy MY. The analysis of effectiveness of isolated and combined prescription of non-opioid analgesics and adjutants during different surgery. Regional Anesthesia and Acute Pain Management. 2015;9(3):19–28. doi: 10.17816/RA36257
  20. Richman JM, Liu SS, Courpas G, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102(1):248–257. doi: 10.1213/01.ane.0000181289.09675.7d
  21. Fischer HBJ, Simanski CJ, Sharp C, et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63(10):1105–1123. doi: 10.1111/j.1365-2044.2008.05565.x
  22. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology. 2012;116(2):248–273. doi: 10.1097/ALN.0b013e31823c1030
  23. Bell RF, Eccleston C, Kalso EA. Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database of Systematic Reviews. 2017;(6) doi: 10.1002/14651858.CD003351.pub3
  24. Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Medicine. 2015;16(2):383–403. doi: 10.1111/pme.12619
  25. Guillou N, Tanguy M, Seguin P, et al. The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Anesthesia & Analgesia. 2003;97(3):843–847. doi: 10.1213/01.ane.0000075837.67275.36
  26. Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesthesia & Analgesia. 2004;99(2):482–495. doi: 10.1213/01.ane.0000118109.12855.07
  27. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Canadian Journal of Anesthesia. 2011;58(10):911–923. doi: 10.1007/s12630-011-9560-0
  28. McNicol ED, Schumann R, Haroutounian S. A systematic review and meta-analysis of ketamine for the prevention of persistent postoperative pain. Acta Anaesthesiologica Scandinavica. 2014;58(10):1199–1213. doi: 10.1111/aas.12377
  29. Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS Neuroscience & Therapeutics. 2013;19(6):370–380. doi: 10.1111/cns.12099
  30. Persson J. Ketamine in pain management. CNS Neuroscience & Therapeutics. 2013;19(6):396–402. doi: 10.1111/cns.12111
  31. Bowdle TA, Radant AD, Cowley DS, Kharasch ED, Strassman RJ, Roy-Byrne PP. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology. 1998;88(1):82–88. doi: 10.1097/00000542-199801000-00015
  32. Lahtinen P, Kokki H, Hakala T, Hynynen M. S(+)-Ketamine as an Analgesic Adjunct Reduces Opioid Consumption After Cardiac Surgery. Anesthesia & Analgesia. 2004;99(5):1295–1301. doi: 10.1213/01.ane.0000133913.07342.b9
  33. Aldecoa C, Bettelli G, Bilotta F, et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol. 2024;41(2):81–108. doi: 10.1097/EJA.0000000000001876
  34. Sigtermans MJ, van Hilten JJ, Bauer MC, et al. Ketamine produces effective and long-term pain relief in patients with complex regional pain syndrome type 1. Pain. 2009;145(3):304–311. doi: 10.1016/j.pain.2009.06.023
  35. Jonkman K, van Rijnsoever E, Olofsen E, et al. Esketamine counters opioid-induced respiratory depression. British Journal of Anaesthesia. 2018;120(5):1117–1127. doi: 10.1016/j.bja.2018.02.021
  36. Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database of Systematic Reviews. 2006;(4). doi: 10.1002/14651858.CD003348.pub2
  37. Elia N, Tramer MR. Ketamine and postoperative pain—a quantitative systematic review of randomised trials. Pain. 2005;113(1-2):61–70. doi: 10.1016/j.pain.2004.09.036
  38. Qi Y, Zhou M, Zheng W, et al. Effect of S-Ketamine on Postoperative Nausea and Vomiting in Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial. Drug Des Devel Ther. 2024;18:1189–1198. doi: 10.2147/DDDT.S449705
  39. De Kock M, Lavand'homme P, Waterloos H. "Balanced analgesia" in the perioperative period: is there a place for ketamine? Pain. 2001;92(3):373–380. doi: 10.1016/s0304-3959(01)00278-0
  40. Bell RF, Dahl JB, Moore RA, Kalso E. Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review. Acta Anaesthesiologica Scandinavica. 2006;50(7):844–861. doi: 10.1111/j.1399-6576.2005.00814.x
  41. Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40(1):23–29. doi: 10.1093/ageing/afq140
  42. Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry. 2018;33(11):1428–1457. doi: 10.1002/gps.4823

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Eco-Vector,


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г.