Skip to main content
Erschienen in: Current Pain and Headache Reports 9/2023

28.06.2023 | Acute Pain Medicine (R Urman, Section Editor)

The Emerging Role of Ketamine in Acute Postoperative Pain Management

verfasst von: Amber N. Edinoff, Dorothy Askins, Elena Bobo, Kathryn L. White, Zahaan Eswani, Eric D. Jackson, Danielle M. Wenger, Aaron J. Kaye, Elyse M. Cornett., Adam M. Kaye, Alan D. Kaye

Erschienen in: Current Pain and Headache Reports | Ausgabe 9/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Postoperative pain (POP) is among the most unpleasant experiences that patients face after surgery. Interest in and use of N-methyl-D-aspartate (NMDA) receptor antagonists for the management of POP has increased over the years with ketamine being the most popular drug of this class.

Recent Findings

Several randomized controlled trials found that the use of ketamine either alone or in combination with other medications leads to decreased postoperative pain and opioid consumption. However, there are other studies that have not found these benefits. The results as of now suggest that the role of intraoperative ketamine in postoperative pain control varies among different operative procedures.

Summary

While some studies have shown promise in ketamine’s potential use as a postoperative analgesic, there is still a great deal of proposed research and randomized controlled trials needed to deduce the most efficacious and tolerable form and dose of ketamine.
Literatur
1.
Zurück zum Zitat Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am. 2015;95(2):301–18.CrossRefPubMed Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control. Surg Clin North Am. 2015;95(2):301–18.CrossRefPubMed
2.
Zurück zum Zitat Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: a narrative review. BioMed Res Int. 2015;2015:749837. Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: a narrative review. BioMed Res Int. 2015;2015:749837.
3.
Zurück zum Zitat Meeks NM, Glass JS, Carroll BT. Acute pain management in dermatology: mechanisms and pathways. J Am Acad Dermatol. 2015 Oct;73(4):533–40; quiz 541–2. Meeks NM, Glass JS, Carroll BT. Acute pain management in dermatology: mechanisms and pathways. J Am Acad Dermatol. 2015 Oct;73(4):533–40; quiz 541–2.
5.
Zurück zum Zitat Coll AM, Jones R. Role of the nurse in the assessment and management of post-operative pain. Nurs Stand R Coll Nurs G B 1987. 2020 Apr 1;35(4):53–8. Coll AM, Jones R. Role of the nurse in the assessment and management of post-operative pain. Nurs Stand R Coll Nurs G B 1987. 2020 Apr 1;35(4):53–8.
6.
Zurück zum Zitat Weisman S. Naproxen for post-operative pain. J Pharm Pharm Sci Publ Can Soc Pharm Sci Soc Can Sci Pharm. 2021;24:62–70. Weisman S. Naproxen for post-operative pain. J Pharm Pharm Sci Publ Can Soc Pharm Sci Soc Can Sci Pharm. 2021;24:62–70.
8.
Zurück zum Zitat Wu MS, Chen KH, Chen IF, Huang SK, Tzeng PC, Yeh ML, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS ONE. 2016;11(3): e0150367.CrossRefPubMedPubMedCentral Wu MS, Chen KH, Chen IF, Huang SK, Tzeng PC, Yeh ML, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS ONE. 2016;11(3): e0150367.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211–20.CrossRefPubMed Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211–20.CrossRefPubMed
10.
11.
Zurück zum Zitat Grancaric N, Lee W, Scanlon M. Postoperative analgesia in the chronic pain patient. Otolaryngol Clin North Am. 2020;53(5):843–52.CrossRefPubMed Grancaric N, Lee W, Scanlon M. Postoperative analgesia in the chronic pain patient. Otolaryngol Clin North Am. 2020;53(5):843–52.CrossRefPubMed
12.
Zurück zum Zitat Coluzzi F, Bifulco F, Cuomo A, Dauri M, Leonardi C, Melotti RM, et al. The challenge of perioperative pain management in opioid-tolerant patients. Ther Clin Risk Manag. 2017;5(13):1163–73.CrossRef Coluzzi F, Bifulco F, Cuomo A, Dauri M, Leonardi C, Melotti RM, et al. The challenge of perioperative pain management in opioid-tolerant patients. Ther Clin Risk Manag. 2017;5(13):1163–73.CrossRef
13.
Zurück zum Zitat Argoff CE. Recent management advances in acute postoperative pain. Pain Pract Off J World Inst Pain. 2014;14(5):477–87. Argoff CE. Recent management advances in acute postoperative pain. Pain Pract Off J World Inst Pain. 2014;14(5):477–87.
14.
Zurück zum Zitat Radvansky BM, Puri S, Sifonios AN, Eloy JD, Le V. Ketamine-a narrative review of its uses in medicine. Am J Ther. 2016;23(6):e1414–26.CrossRefPubMed Radvansky BM, Puri S, Sifonios AN, Eloy JD, Le V. Ketamine-a narrative review of its uses in medicine. Am J Ther. 2016;23(6):e1414–26.CrossRefPubMed
15.
Zurück zum Zitat Wang X, Lin C, Lan L, Liu J. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis. J Clin Anesth. 2021;68: 110071.CrossRefPubMed Wang X, Lin C, Lan L, Liu J. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis. J Clin Anesth. 2021;68: 110071.CrossRefPubMed
17.
Zurück zum Zitat Feifel D. Breaking sad: unleashing the breakthrough potential of ketamine’s rapid antidepressant effects. Drug Dev Res. 2016;77(8):489–94.CrossRefPubMed Feifel D. Breaking sad: unleashing the breakthrough potential of ketamine’s rapid antidepressant effects. Drug Dev Res. 2016;77(8):489–94.CrossRefPubMed
19.
Zurück zum Zitat Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2013;38(12):2475–83.CrossRef Rodriguez CI, Kegeles LS, Levinson A, Feng T, Marcus SM, Vermes D, et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2013;38(12):2475–83.CrossRef
20.
Zurück zum Zitat Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, et al. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Am J Psychiatry. 2021;178(2):193–202.CrossRefPubMed Feder A, Costi S, Rutter SB, Collins AB, Govindarajulu U, Jha MK, et al. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Am J Psychiatry. 2021;178(2):193–202.CrossRefPubMed
22.
Zurück zum Zitat Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesthesiol Res Pract. 2020;1(2020):5798285. Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesthesiol Res Pract. 2020;1(2020):5798285.
24.
Zurück zum Zitat Verkhratsky A, Kirchhoff F. NMDA receptors in glia. Neurosci Rev J Bringing Neurobiol Neurol Psychiatry. 2007;13(1):28–37. Verkhratsky A, Kirchhoff F. NMDA receptors in glia. Neurosci Rev J Bringing Neurobiol Neurol Psychiatry. 2007;13(1):28–37.
25.
Zurück zum Zitat Raghunatha P, Vosoughi A, Kauppinen TM, Jackson MF. Microglial NMDA receptors drive pro-inflammatory responses via PARP-1/TRMP2 signaling. Glia. 2020;68(7):1421–34.CrossRefPubMed Raghunatha P, Vosoughi A, Kauppinen TM, Jackson MF. Microglial NMDA receptors drive pro-inflammatory responses via PARP-1/TRMP2 signaling. Glia. 2020;68(7):1421–34.CrossRefPubMed
26.
Zurück zum Zitat Nichols KA, Paciullo CA. Subdissociative ketamine use in the emergency department. Adv Emerg Nurs J. 2019;41(1):15–22.CrossRefPubMed Nichols KA, Paciullo CA. Subdissociative ketamine use in the emergency department. Adv Emerg Nurs J. 2019;41(1):15–22.CrossRefPubMed
27.
Zurück zum Zitat Niesters M, Khalili-Mahani N, Martini C, Aarts L, van Gerven J, van Buchem MA, et al. Effect of subanesthetic ketamine on intrinsic functional brain connectivity: a placebo-controlled functional magnetic resonance imaging study in healthy male volunteers. Anesthesiology. 2012;117(4):868–77.CrossRefPubMed Niesters M, Khalili-Mahani N, Martini C, Aarts L, van Gerven J, van Buchem MA, et al. Effect of subanesthetic ketamine on intrinsic functional brain connectivity: a placebo-controlled functional magnetic resonance imaging study in healthy male volunteers. Anesthesiology. 2012;117(4):868–77.CrossRefPubMed
28.
Zurück zum Zitat Rogers R, Wise RG, Painter DJ, Longe SE, Tracey I. An investigation to dissociate the analgesic and anesthetic properties of ketamine using functional magnetic resonance imaging. Anesthesiology. 2004;100(2):292–301.CrossRefPubMed Rogers R, Wise RG, Painter DJ, Longe SE, Tracey I. An investigation to dissociate the analgesic and anesthetic properties of ketamine using functional magnetic resonance imaging. Anesthesiology. 2004;100(2):292–301.CrossRefPubMed
29.
Zurück zum Zitat BinKharfi M, AlSagre A. BET 2: Safety and efficacy of low-dose ketamine versus opioids for acute pain management in the ED. Emerg Med J EMJ. 2019;36(2):128–9.CrossRefPubMed BinKharfi M, AlSagre A. BET 2: Safety and efficacy of low-dose ketamine versus opioids for acute pain management in the ED. Emerg Med J EMJ. 2019;36(2):128–9.CrossRefPubMed
31.
Zurück zum Zitat Touil N, Pavlopoulou A, Barbier O, Libouton X, Lavand’homme P. Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study. Br J Anaesth. 2022;128(4):734–41. Touil N, Pavlopoulou A, Barbier O, Libouton X, Lavand’homme P. Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: a prospective randomised, double-blind, placebo-controlled study. Br J Anaesth. 2022;128(4):734–41.
32.
Zurück zum Zitat • Murphy GS, Avram MJ, Greenberg SB, Benson J, Bilimoria S, Maher CE, et al. Perioperative methadone and ketamine for postoperative pain control in spinal surgical patients: a randomized, double-blind, placebo-controlled trial. Anesth. 2021;134(5):697–708. Marked as one of the important references in this manuscript as it is very recent and showed that the use of IV ketamine can help with pain and decrease opioid requirement. • Murphy GS, Avram MJ, Greenberg SB, Benson J, Bilimoria S, Maher CE, et al. Perioperative methadone and ketamine for postoperative pain control in spinal surgical patients: a randomized, double-blind, placebo-controlled trial. Anesth. 2021;134(5):697–708. Marked as one of the important references in this manuscript as it is very recent and showed that the use of IV ketamine can help with pain and decrease opioid requirement.
33.
Zurück zum Zitat • Muñoz-Leyva F, Jack JM, Bhatia A, Chin KJ, Gandhi R, Perlas A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesth. 2022;137(4):459–70. Marked as important as it showed the opposite of the study that Murphy et al. showed; however, there were confounding factors that should be highlighted in this study. It shows that other factors may be at play and that ketamine could still be a viable option. • Muñoz-Leyva F, Jack JM, Bhatia A, Chin KJ, Gandhi R, Perlas A, et al. No benefits of adding dexmedetomidine, ketamine, dexamethasone, and nerve blocks to an established multimodal analgesic regimen after total knee arthroplasty. Anesth. 2022;137(4):459–70. Marked as important as it showed the opposite of the study that Murphy et al. showed; however, there were confounding factors that should be highlighted in this study. It shows that other factors may be at play and that ketamine could still be a viable option.
34.
Zurück zum Zitat • Cheng X, Wang H, Diao M, Jiao H. Effect of S-ketamine on postoperative quality of recovery in patients undergoing video-assisted thoracic surgery. J Cardiothorac Vasc Anesth. 2022;36(8 Pt B):3049–56. This study is important as not only did the ketamine help with postoperative pain control but it was noted that patients had decreased coughing. This is important in VATS procedures in thoracic surgery as coughing adds to pain. • Cheng X, Wang H, Diao M, Jiao H. Effect of S-ketamine on postoperative quality of recovery in patients undergoing video-assisted thoracic surgery. J Cardiothorac Vasc Anesth. 2022;36(8 Pt B):3049–56. This study is important as not only did the ketamine help with postoperative pain control but it was noted that patients had decreased coughing. This is important in VATS procedures in thoracic surgery as coughing adds to pain.
35.
Zurück zum Zitat Ates I, Aydin ME, Celik EC, Gozeler MS, Ahiskalioglu A. Perioperative intravenous low-dose ketamine infusion to minimize pain for septorhinoplasty: a prospective, randomized, double-blind study. Ear Nose Throat J. 2021;100(4):254–9.CrossRefPubMed Ates I, Aydin ME, Celik EC, Gozeler MS, Ahiskalioglu A. Perioperative intravenous low-dose ketamine infusion to minimize pain for septorhinoplasty: a prospective, randomized, double-blind study. Ear Nose Throat J. 2021;100(4):254–9.CrossRefPubMed
36.
Zurück zum Zitat Zhao Z, Xu Q, Chen Y, Liu C, Zhang F, Han Y, et al. The effect of low-dose ketamine on postoperative quality of recovery in patients undergoing breast cancer surgery: a randomised, placebo-controlled trial. Int J Clin Pract. 2021;75(12): e15010.CrossRefPubMed Zhao Z, Xu Q, Chen Y, Liu C, Zhang F, Han Y, et al. The effect of low-dose ketamine on postoperative quality of recovery in patients undergoing breast cancer surgery: a randomised, placebo-controlled trial. Int J Clin Pract. 2021;75(12): e15010.CrossRefPubMed
37.
Zurück zum Zitat Jain S, Nazir N, Mustafi SM. Preemptive low-dose intravenous ketamine in the management of acute and chronic postoperative pain following laparoscopic cholecystectomy: a prospective randomized control study. Med Gas Res. 2022;12(4):141–5.CrossRefPubMedPubMedCentral Jain S, Nazir N, Mustafi SM. Preemptive low-dose intravenous ketamine in the management of acute and chronic postoperative pain following laparoscopic cholecystectomy: a prospective randomized control study. Med Gas Res. 2022;12(4):141–5.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Nayak BM, Misra S, Mitra JK, Sahoo AK. Effect of preoperative subanaesthetic ketamine on postoperative pain in women undergoing modified radical mastectomy: a randomised control trial. Eur J Anaesthesiol. 2021;38(5):556–8.CrossRefPubMed Nayak BM, Misra S, Mitra JK, Sahoo AK. Effect of preoperative subanaesthetic ketamine on postoperative pain in women undergoing modified radical mastectomy: a randomised control trial. Eur J Anaesthesiol. 2021;38(5):556–8.CrossRefPubMed
39.
Zurück zum Zitat Tajerian M, Leu D, Yang P, Huang TT, Kingery WS, Clark JD. Differential efficacy of ketamine in the acute versus chronic stages of complex regional pain syndrome in mice. Anesthesiology. 2015;123(6):1435–47.CrossRefPubMed Tajerian M, Leu D, Yang P, Huang TT, Kingery WS, Clark JD. Differential efficacy of ketamine in the acute versus chronic stages of complex regional pain syndrome in mice. Anesthesiology. 2015;123(6):1435–47.CrossRefPubMed
Metadaten
Titel
The Emerging Role of Ketamine in Acute Postoperative Pain Management
verfasst von
Amber N. Edinoff
Dorothy Askins
Elena Bobo
Kathryn L. White
Zahaan Eswani
Eric D. Jackson
Danielle M. Wenger
Aaron J. Kaye
Elyse M. Cornett.
Adam M. Kaye
Alan D. Kaye
Publikationsdatum
28.06.2023
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports / Ausgabe 9/2023
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-023-01134-1

Weitere Artikel der Ausgabe 9/2023

Current Pain and Headache Reports 9/2023 Zur Ausgabe

Hot Topics in Pain and Headache (N Rosen, Section Editor)

Multi-agent Systems and Cancer Pain Management

Alternative Treatments for Pain Medicine (M Jones, Section Editor)

Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses

Neuropathic Pain (A Abd-Elsayed, Section Editor)

A Brief Review on the Novel Therapies for Painful Diabetic Neuropathy

Mit dem Seitenschneider gegen das Reißverschluss-Malheur

03.06.2024 Urologische Notfallmedizin Nachrichten

Wer ihn je erlebt hat, wird ihn nicht vergessen: den Schmerz, den die beim Öffnen oder Schließen des Reißverschlusses am Hosenschlitz eingeklemmte Haut am Penis oder Skrotum verursacht. Eine neue Methode für rasche Abhilfe hat ein US-Team getestet.

Blutdrucksenkung schon im Rettungswagen bei akutem Schlaganfall?

31.05.2024 Apoplex Nachrichten

Der optimale Ansatz für die Blutdruckkontrolle bei Patientinnen und Patienten mit akutem Schlaganfall ist noch nicht gefunden. Ob sich eine frühzeitige Therapie der Hypertonie noch während des Transports in die Klinik lohnt, hat jetzt eine Studie aus China untersucht.

Ähnliche Überlebensraten nach Reanimation während des Transports bzw. vor Ort

29.05.2024 Reanimation im Kindesalter Nachrichten

Laut einer Studie aus den USA und Kanada scheint es bei der Reanimation von Kindern außerhalb einer Klinik keinen Unterschied für das Überleben zu machen, ob die Wiederbelebungsmaßnahmen während des Transports in die Klinik stattfinden oder vor Ort ausgeführt werden. Jedoch gibt es dabei einige Einschränkungen und eine wichtige Ausnahme.

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.