Perioperative Ketamine Administration for Thoracotomy Pain

Area of Science:

• Anesthesiology and Pain Management
• Surgical Recovery
• Pharmacology

Background:

• Post-thoracotomy pain presents a significant therapeutic challenge due to its prevalence and severity.
• Multimodal analgesic strategies are essential for managing post-thoracotomy pain.
• N-Methyl-D-Aspartate (NMDA) receptor antagonists, like ketamine, are explored as adjuncts in pain management.

Purpose of the Study:

• To review evidence on ketamine's efficacy in acute post-thoracotomy pain.
• To assess ketamine's effectiveness in reducing chronic post-thoracotomy pain.
• To evaluate intravenous and epidural ketamine administration for pain management.

Main Methods:

• Systematic literature review and data subset analysis.
• Searched PubMed, Embase, and Cochrane reviews for studies published before January 2015.
• Included randomized controlled trials and retrospective studies; excluded animal data, abstracts, letters, and non-English articles.

Main Results:

• 15 randomized controlled trials evaluated ketamine for acute post-thoracotomy pain.
• The majority of studies showed ketamine's efficacy in reducing acute pain.
• Limited evidence exists for ketamine's long-term benefits in preventing chronic post-thoracotomy pain syndrome due to study heterogeneity.

Conclusions:

• Ketamine demonstrates efficacy in reducing acute post-thoracotomy pain.
• Current evidence is insufficient to establish ketamine's role in preventing chronic post-thoracotomy pain syndrome.
• Additional research is warranted to explore ketamine's long-term effects and optimal use in preventing chronic pain.