Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid-dependent patients
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Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery : A randomized clinical trial of opioid-dependent patients. / Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Nikolajsen, Lone; Dahl, Jørgen Berg; Mathiesen, Ole.
In: European Journal of Pain, Vol. 23, No. 3, 03.2019, p. 455-460.Research output: Contribution to journal › Letter › Research › peer-review
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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 -
ID: 234282900