This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Adam, F. Articles by Fletcher, D. Search for Related Content PubMed PubMed Citation Articles by Adam, F. Articles by Fletcher, D.

---

PAIN MEDICINE

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

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 Research^TM 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:

				P. F. White, B. Tufanogullari, J. Taylor, and K. Klein The Effect of Pregabalin on Preoperative Anxiety and Sedation Levels: A Dose-Ranging Study Anesth. Analg., April 1, 2009; 108(4): 1140 - 1145. [Abstract] [Full Text] [PDF]

				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]

				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]

				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]