TY - JOUR

T1 - Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery

T2 - A randomized clinical trial of opioid-dependent patients

AU - Nielsen, Rikke Vibeke

AU - Fomsgaard, Jonna Storm

AU - Nikolajsen, Lone

AU - Dahl, Jørgen Berg

AU - Mathiesen, Ole

N1 - © 2018 European Pain Federation - EFIC®.

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: We 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.METHODS: Single-centre, randomized, blinded trial of 147 patients.INTERVENTION: Perioperative S-ketamine bolus 0.5 mg/kg followed by S-ketamine 0.25 mg kg-1 hr-1 infusion or placebo.MAIN OUTCOMES: Analgesic use, pain (visual analogue scale 0-100 mm [VAS]) and labour market attachment one year after surgery assessed by written questionnaires.RESULTS: Response 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).CONCLUSION: Intraoperative ketamine may reduce analgesic use, pain, and improve labour market attachment one year after spine surgery in a chronic opioid-dependent population.SIGNIFICANCE: This 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.

AB - BACKGROUND: We 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.METHODS: Single-centre, randomized, blinded trial of 147 patients.INTERVENTION: Perioperative S-ketamine bolus 0.5 mg/kg followed by S-ketamine 0.25 mg kg-1 hr-1 infusion or placebo.MAIN OUTCOMES: Analgesic use, pain (visual analogue scale 0-100 mm [VAS]) and labour market attachment one year after surgery assessed by written questionnaires.RESULTS: Response 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).CONCLUSION: Intraoperative ketamine may reduce analgesic use, pain, and improve labour market attachment one year after spine surgery in a chronic opioid-dependent population.SIGNIFICANCE: This 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.

KW - Adult

KW - Analgesics/administration & dosage

KW - Analgesics, Opioid/therapeutic use

KW - Double-Blind Method

KW - Drug Administration Schedule

KW - Female

KW - Humans

KW - Intraoperative Care

KW - Ketamine/administration & dosage

KW - Male

KW - Middle Aged

KW - Morphine/therapeutic use

KW - Opioid-Related Disorders/psychology

KW - Pain Measurement

KW - Pain, Postoperative/diagnosis

KW - Spinal Fusion/adverse effects

U2 - 10.1002/ejp.1317

DO - 10.1002/ejp.1317

M3 - Letter

C2 - 30246357

VL - 23

SP - 455

EP - 460

JO - European Journal of Pain

JF - European Journal of Pain

SN - 1090-3801

IS - 3

ER -