JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (10)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Adam, F.
Right arrow Articles by Fletcher, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Adam, F.
Right arrow Articles by Fletcher, D.

Anesth Analg 2005;100:475-480
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000142117.82241.DC

PAIN MEDICINE

Small-Dose Ketamine Infusion Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty

Frédéric Adam, MD, Marcel Chauvin, MD, Bertrand Du Manoir, MD, Mathieu Langlois, MD, Daniel I. Sessler, MD, and Dominique Fletcher, MD

Departments of Anesthesia and INSERM E 332, Hôpital Ambroise Pare, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne, France; Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 92428 Garches, France; and the Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky

Address correspondence and reprint requests to Marcel Chauvin, MD, Publique-Hôpitaux de Paris, 92100 Boulogne, France. Address e-mail to marcel.chauvin{at}apr.ap-hop-paris.fr.

We designed this study to evaluate the effect of small-dose IV ketamine in combination with continuous femoral nerve block on postoperative pain and rehabilitation after total knee arthroplasty. Continuous femoral nerve block was started with 0.3 mL/kg of 0.75% ropivacaine before surgery and continued in the surgical ward for 48 h with 0.2% ropivacaine at a rate of 0.1 mL · kg–1 · h–1. Patients were randomly assigned to receive an initial bolus of 0.5 mg/kg ketamine followed by a continuous infusion of 3 µg · kg–1 · min–1 during surgery and 1.5 µg · kg–1 · min–1 for 48 h (ketamine group) or an equal volume of saline (control group). Additional postoperative analgesia was provided by patient-controlled IV morphine. Pain scores and morphine consumption were recorded over 48 h. The maximal degree of active knee flexion tolerated was recorded daily until hospital discharge. Follow-up was performed 6 wk and 3 mo after surgery. The ketamine group required significantly less morphine than the control group (45 ± 20 mg versus 69 ± 30 mg; P < 0.02). Patients in the ketamine group reached 90° of active knee flexion more rapidly than those in the control group (at 7 [5–11] versus 12 [8–45] days, median [25%–75% interquartile range]; P < 0.03). Outcomes at 6 wk and 3 mo were similar in each group. These results confirm that ketamine is a useful analgesic adjuvant in perioperative multimodal analgesia with a positive impact on early knee mobilization. No patient in either group reported sedation, hallucinations, nightmares, or diplopia, and no differences were noted in the incidence of nausea and vomiting between the two groups.




This article has been cited by other articles:


Home page
 JBJSHome page
S. S. Reuben and A. Buvanendran
Preventing the Development of Chronic Pain After Orthopaedic Surgery with Preventive Multimodal Analgesic Techniques
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1343 - 1358.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
F. Adam, C. Menigaux, D. I. Sessler, and M. Chauvin
A Single Preoperative Dose of Gabapentin (800 Milligrams) Does Not Augment Postoperative Analgesia in Patients Given Interscalene Brachial Plexus Blocks for Arthroscopic Shoulder Surgery
Anesth. Analg., November 1, 2006; 103(5): 1278 - 1282.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
T. T. Horlocker, S. L. Kopp, M. W. Pagnano, and J. R. Hebl
Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block.
J. Am. Acad. Ortho. Surg., March 1, 2006; 14(3): 126 - 135.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.