JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (27) Citing Articles via Google Scholar Google Scholar Articles by Jaksch, W. Articles by Fitzal, S. Search for Related Content PubMed PubMed Citation Articles by Jaksch, W. Articles by Fitzal, S. Related Collections Pain Pharmacology

---

PAIN MEDICINE

Perioperative Small-Dose S(+)-Ketamine Has No Incremental Beneficial Effects on Postoperative Pain When Standard-Practice Opioid Infusions Are Used

Wolfgang Jaksch, MD, DEAA^*, Stefan Lang, MD, DEAA^*, Robert Reichhalter, MD^*, Gerald Raab, MD, DEAA^*, Klaus Dann, MD, and Sylvia Fitzal, MD^*

*Department of Anesthesiology and Intensive Care Medicine, Ludwig Boltzmann Institute of Experimental Anesthesiology and Research in Intensive Care Medicine; and Department of Traumatology, Wilhelminenspital, Vienna, Austria

Address correspondence and reprint requests to Wolfgang Jaksch, MD, DEAA, Department of Anesthesiology and Intensive Care Medicine, Wilhelminenspital, Montleartstrasse 37, 1171 Vienna, Austria. Address e-mail to wolfgang.jaksch{at}chello.at

Several studies report that when small-dose racemic ketamine, an N-methyl-D-aspartate receptor antagonist, is administered perioperatively, opioid consumption is reduced postoperatively. S(+)-ketamine has a higher affinity for the N-methyl-D-aspartate receptor and less-serious side effects than racemic ketamine. Thirty patients scheduled for elective arthroscopic anterior cruciate ligament repair were enrolled in this randomized, double-blinded clinical trial designed to determine the preemptive effect of S(+)-ketamine on postoperative analgesia requirements in a setting of clinically relevant perioperative analgesia. Total IV anesthesia was induced and maintained with remifentanil (0.125–1.0 µg · kg^-1 · min^-1) and a propofol target-controlled infusion (target 2–4 µg/mL). The Ketamine group received a bolus of 0.5 mg/kg S(+)-ketamine before incision, followed by a continuing infusion of 2 µg · kg^-1 · min^-1 until 2 h after emergence from anesthesia. The Control group received NaCl in the same sequence. After IV morphine provided pain relief down to 3 on a visual analog scale scored from 0 to 10, patients were connected to a patient-controlled analgesia device. There were no significant differences between the two groups in terms of total morphine consumption or VAS scores, either at rest or with movement. In our study, S(+)-ketamine did not contribute to postoperative pain reduction, possibly because of the clinically routine perioperative opioid analgesia.

IMPLICATIONS: Small-dose S(+)-ketamine had no positive effect on postoperative analgesia when administered perioperatively for elective arthroscopic anterior cruciate ligament repair. Unlike investigations of the racemic mixture of ketamine, our study methods included timely standard-practice perioperative opioid analgesia, which seems to make supplemental analgesia unnecessary.

This article has been cited by other articles:

				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]

				J. R. Sneyd Recent advances in intravenous anaesthesia Br. J. Anaesth., November 1, 2004; 93(5): 725 - 736. [Abstract] [Full Text] [PDF]

				P. Lahtinen, H. Kokki, T. Hakala, and M. Hynynen S(+)-Ketamine as an Analgesic Adjunct Reduces Opioid Consumption After Cardiac Surgery Anesth. Analg., November 1, 2004; 99(5): 1295 - 1301. [Abstract] [Full Text] [PDF]

				A. C. Van Elstraete, T. Lebrun, I. Sandefo, B. Polin, R. K. F. Kwok, M. T. V. Chan, and T. Gin Are Preemptive Analgesic Effects of Ketamine Linked to Inadequate Perioperative Analgesia? * Response Anesth. Analg., November 1, 2004; 99(5): 1576 - 1576. [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]

				H. Argiriadou, S. Himmelseher, P. Papagiannopoulou, M. Georgiou, F. Kanakoudis, M. Giala, and E. Kochs Improvement of Pain Treatment After Major Abdominal Surgery by Intravenous S(+)-Ketamine Anesth. Analg., May 1, 2004; 98(5): 1413 - 1418. [Abstract] [Full Text] [PDF]

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