Chronic postthoracotomy pain and perioperative ketamine infusion

Area of Science:

• Anesthesiology
• Pain Management
• Thoracic Surgery

Background:

• Chronic postthoracotomy pain (CPTP) is a significant complication following thoracic surgery.
• Effective strategies to prevent CPTP are crucial for patient recovery and quality of life.

Purpose of the Study:

• To evaluate the efficacy of continuous intravenous ketamine in reducing the incidence and intensity of CPTP.
• To identify the incidence and independent risk factors associated with CPTP.

Main Methods:

• A randomized controlled trial involving 78 patients undergoing thoracotomy for lung tumors.
• Patients were assigned to receive either continuous intravenous ketamine infusion for 72 hours or a saline placebo, alongside patient-controlled analgesia.
• Pain scores (NRS) and CPTP incidence were assessed at 2 and 6 months post-surgery.

Main Results:

• Continuous intravenous ketamine did not significantly decrease the incidence or intensity of CPTP at 2 or 6 months compared to the control group.
• The overall incidence of CPTP was high, recorded at 78.2% at 2 months and 53.8% at 6 months.
• Independent risk factors for CPTP included longer retractor use time, inadequate acute pain control (NRS ≥ 5), and undergoing chemotherapy.

Conclusions:

• Continuous intravenous ketamine infusion at 2 μg/kg/min for 72 hours post-thoracotomy is not effective in preventing chronic postthoracotomy pain.
• Prolonged retractor use, insufficient acute pain management, and chemotherapy are significant risk factors contributing to the development of CPTP.