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 (35) Citing Articles via Google Scholar Google Scholar Articles by Menigaux, C. Articles by Chauvin, M. Search for Related Content PubMed PubMed Citation Articles by Menigaux, C. Articles by Chauvin, M. Related Collections Ambulatory Pharmacology

---

AMBULATORY ANESTHESIA

Intraoperative Small-Dose Ketamine Enhances Analgesia After Outpatient Knee Arthroscopy

Christophe Menigaux, MD^*, Bruno Guignard, MD^*, Dominique Fletcher, MD^*, Daniel I. Sessler, MD, Xavier Dupont, MD^*, and Marcel Chauvin, MD^*

*Department of Anesthesiology, Hôpital Ambroise Pare, Boulogne-Billancourt, France; and Outcomes Research^TM Institute and Department of Anesthesiology, University of Louisville, Louisville, KY, and Ludwig Boltzmann Anesthesia Institute, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Marcel Chauvin, MD, Department of Anesthesiology, Hôpital Ambroise Pare, 9 Avenue Charles de Gaulle, Boulogne-Billancourt, 92100, France. Address e-mail to marcel.chauvin{at}apr.ap-hop-paris.fr

Ketamine may prevent postoperative hyperalgesia. In patients undergoing arthroscopic meniscectomy using general anesthesia, we tested whether a single intraoperative dose of ketamine enhanced postoperative analgesia and improved functional outcome compared with a typical multimodal analgesic regimen. After the induction of anesthesia, 50 patients were randomly assigned to ketamine (0.15 mg/kg IV just after the induction of anesthesia) or a vehicle placebo. Standardized general anesthesia included propofol, alfentanil, and nitrous oxide. Bupivacaine (0.5%) and morphine (5 mg) were given intraarticularly at the end of surgery. Postoperative analgesia was initially provided with morphine and subsequently with naproxen sodium (550 mg orally twice daily) and Di-Antalvic^® (400 mg acetaminophen and 30 mg dextropropoxyphene) as needed. Pain scores, analgesic requirements, side effects, and ability to walk were assessed in the ambulatory unit and at home for three postoperative days. Times to awakening and to discharge were similar in the two groups. However, the Ketamine group had significantly less postoperative pain at rest and during mobilization on Days 0, 1, and 2. Furthermore, they consumed significantly fewer Di-Antalvic^® tablets than the control group (13 [7–17] vs 27 [16–32], median [25%–75% interquartile range]). Patients given ketamine were also able to walk for longer periods of time on the first postoperative day. In conclusion, adding small-dose ketamine to a multimodal analgesic regimen improved postoperative analgesia and functional outcome after outpatient knee arthroscopy.

IMPLICATIONS: Intraoperative small-dose ketamine proved a safe and effective adjunct to a multimodal analgesic regimen, improving both postoperative analgesia and functional outcome after outpatient arthroscopic meniscectomy.

This article has been cited by other articles:

				F. Remerand, C. Le Tendre, A. Baud, C. Couvret, X. Pourrat, L. Favard, M. Laffon, and J. Fusciardi The Early and Delayed Analgesic Effects of Ketamine After Total Hip Arthroplasty: A Prospective, Randomized, Controlled, Double-Blind Study Anesth. Analg., December 1, 2009; 109(6): 1963 - 1971. [Abstract] [Full Text] [PDF]

				M. Yamauchi, M. Asano, M. Watanabe, S. Iwasaki, S. Furuse, and A. Namiki Continuous Low-Dose Ketamine Improves the Analgesic Effects of Fentanyl Patient-Controlled Analgesia After Cervical Spine Surgery Anesth. Analg., September 1, 2008; 107(3): 1041 - 1044. [Abstract] [Full Text] [PDF]

				B. Beilin, Y. Rusabrov, Y. Shapira, L. Roytblat, L. Greemberg, I. Z. Yardeni, and H. Bessler Low-dose ketamine affects immune responses in humans during the early postoperative period Br. J. Anaesth., October 1, 2007; 99(4): 522 - 527. [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]

				S. S. Liu, W. M. Strodtbeck, J. M. Richman, and C. L. Wu A Comparison of Regional Versus General Anesthesia for Ambulatory Anesthesia: A Meta-Analysis of Randomized Controlled Trials Anesth. Analg., December 1, 2005; 101(6): 1634 - 1642. [Abstract] [Full Text] [PDF]

				P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]

				F. Saricaoglu, D. Dal, A. E. Salman, M. N. Doral, K. Kilinc, and U. Aypar Ketamine Sedation During Spinal Anesthesia for Arthroscopic Knee Surgery Reduced the Ischemia-Reperfusion Injury Markers Anesth. Analg., September 1, 2005; 101(3): 904 - 909. [Abstract] [Full Text] [PDF]

				P. Hans, P.-Y. Dewandre, J. F. Brichant, and V. Bonhomme Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia Br. J. Anaesth., March 1, 2005; 94(3): 336 - 340. [Abstract] [Full Text] [PDF]

				F. Adam, M. Chauvin, B. Du Manoir, M. Langlois, D. I. Sessler, and D. Fletcher Small-Dose Ketamine Infusion Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty Anesth. Analg., February 1, 2005; 100(2): 475 - 480. [Abstract] [Full Text] [PDF]

				B. Kapfer, P. Alfonsi, B. Guignard, D. I. Sessler, and M. Chauvin Nefopam and Ketamine Comparably Enhance Postoperative Analgesia Anesth. Analg., January 1, 2005; 100(1): 169 - 174. [Abstract] [Full Text] [PDF]

				K. Subramaniam, B. Subramaniam, and R. A. Steinbrook Ketamine as Adjuvant Analgesic to Opioids: A Quantitative and Qualitative Systematic Review Anesth. Analg., August 1, 2004; 99(2): 482 - 495. [Abstract] [Full Text] [PDF]

				C. J. L. McCartney, A. Sinha, and J. Katz A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia Anesth. Analg., May 1, 2004; 98(5): 1385 - 1400. [Abstract] [Full Text] [PDF]

				R. F. K. Kwok, J. Lim, M. T.V Chan, T. Gin, and W. K.Y. Chiu Preoperative Ketamine Improves Postoperative Analgesia After Gynecologic Laparoscopic Surgery Anesth. Analg., April 1, 2004; 98(4): 1044 - 1049. [Abstract] [Full Text] [PDF]

				B. Guignard, C. Coste, H. Costes, D. I. Sessler, C. Lebrault, W. Morris, G. Simonnet, and M. Chauvin Supplementing Desflurane-Remifentanil Anesthesia with Small-Dose Ketamine Reduces Perioperative Opioid Analgesic Requirements Anesth. Analg., July 1, 2002; 95(1): 103 - 108. [Abstract] [Full Text] [PDF]