Intravenous Ketamine for Postoperative Pain Control in Spine Surgery: a Randomized Controlled Study

Authors

  • Yuwarin Kositworakitkun Department of Anesthesiology, Uttaradit hospital, Uttaradit 53000, Thailand

Keywords:

ketamine, postoperative pain, spinal surgery

Abstract

Introduction: Fast recovery after spinal surgery is a crucial goal to allow patients to perform daily activities and leave the hospital sooner. Patients undergoing spinal surgery often experience moderate to severe postoperative pain. Thus, the use of a multimodal analgesia may reduce pain, decrease morphine consumption, and diminish side effects. Methods: This study is a prospective randomized control trial conducted after receiving ethical approval. Patients undergoing spinal surgery were divided into two groups: group 1 received ketamine in addition to morphine, group 2 received only morphine during surgery, with 21 patients in each group. The study assessed the efficacy of ketamine in reducing morphine comsumption and pain scores up to 48 h after surgery. Additionally, the time to siting and ambulation after surgery, as well as the side effects from the pain medications were evaluated. Results: Pain scores in the recovery room, 24 and 48 h after surgery in the ketamine group were significantly lower than in the morphine group (P < 0.05). The morphine comsumption in the recovery room and 24 h after surgery in the ketamine group was significantly lower than in the morphine group (P < 0.05). The severe complications in both groups were none. In addition, the side effects were not significantly different between the two groups. Conclusion: Administration of ketamine during spinal surgery can reduce postoperative pain and decrease morphine consumpion without severe side effects.

References

Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011;58:911-23.

Petrenko AB, Yamakura T, Baba H, Shimoji K. The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003;97:1108-16.

Stoker AD, Rosenfeld DM, Buras MR, Alvord JM, Gorlin AW. Evaluatioin of clinical factors associated with adverse drug events in patients receiving sub-anesthetic ketamine infusions. J Pain Res. 2019;12:3413-21.

Loftus RW, Yeager MP, Clark JA, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113:639-46.

Abrishamkar S, Eshraghi N, Feizi A, Talakoub R, Rafiei A, Rahmani P. Analgesic effects of ketamine infusion on postoperative pain afer fusion and instrumentation of lumbar spine: a prospecitve randomized clinical trial. Med Arh. 2012;66:107-10.

Hadi BA, Daas R, Zelkó R. A randomized, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery-low dose intravenous ketamine as and adjunct to standard therapy. Saudi Pharm J. 2013;21:169-75.

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.

Pendi A, Field R, Farhan SD, Eichier M, Bederman SS. Perioperative ketamine for analgesia in spine surgery: a meta-analysis of randomized controlled trials. Spine. 2018;43:E299-307.

Gelmanas A, Vitartaite M, Tamosiunas R, Macas A. Low-dose ketamine for acute postoperative pain treatment. In: Saiz-Sapena N, Granell-Gil M, eds. Ketamine revisited-new insights into NMDA inhibitors. London: IntechOpen; 2022. Available from: http://dx.doi.org/10.5772/intechopen.100415.

Park PJ, Makhni MC, Cerpa M, Lehman RA, Lenke LG. The role of perioperative ketamine in postoperative pain control following spinal surgery. J Spine Surg. 2020;6:591-7.

Tornoe AS, Pind AH, Laursen CCW, Andersen C, Maagaard M, Mathiesen O. Ketamine for postoperative pain treatment in spinal surgery: systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand. 2023;67:1306-21.

Rodríguez U, Trillo L, García J, Vila E, Soldevilla M. Postoperative ketamine efficacy in patients receiving chronic opioids undergoing spinal surgery. Rev Soc Esp Dolor. 2021;28:92-9.

Park PJ, Makhni MC, Cerpa M, Lehman RA, Lenke LG. The role of perioperative ketamine in postoperative pain control following spinal surgery. J Spine Surg. 2020;6:546-56.

Downloads

Published

2025-03-04

How to Cite

Kositworakitkun , Y. (2025). Intravenous Ketamine for Postoperative Pain Control in Spine Surgery: a Randomized Controlled Study. Thai Journal of Anesthesiology, 51(2), 109–116. retrieved from https://he02.tci-thaijo.org/index.php/anesthai/article/view/274053

Issue

Section

Original articles