• Rikke Vibeke Nielsen, Jonna Storm Fomsgaard, Lone Nikolajsen, Jørgen Berg Dahl, and Ole Mathiesen.
• Department of Neuroanesthesiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Glostrup, Denmark.
• Eur J Pain. 2019 Mar 1; 23 (3): 455-460.

BackgroundWe 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.MethodsSingle-centre, randomized, blinded trial of 147 patients.InterventionPerioperative S-ketamine bolus 0.5 mg/kg followed by S-ketamine 0.25 mg kg-1  hr-1 infusion or placebo.Main OutcomesAnalgesic use, pain (visual analogue scale 0-100 mm [VAS]) and labour market attachment one year after surgery assessed by written questionnaires.ResultsResponse 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).ConclusionIntraoperative ketamine may reduce analgesic use, pain, and improve labour market attachment one year after spine surgery in a chronic opioid-dependent population.SignificanceThis 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®.

27 keywords...

hide…