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Intraoperative Ketamine in Total Knee Arthroplasty Does Not Decrease Pain and Narcotic Consumption: A Prospective

Timothy L Tan1, Andrew S Longenecker2, Janet H Rhee2

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PubMed
Summary
This summary is machine-generated.

Intraoperative ketamine did not significantly reduce postoperative pain or narcotic use in total knee arthroplasty patients receiving spinal anesthesia. This study found no clinically meaningful benefit for ketamine in this specific surgical context.

Keywords:
anesthesiamultimodal pain protocolopioidspainprimary knee arthroplasty

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Orthopedic Surgery

Background:

  • Ketamine, a glutamate receptor blocker, has shown potential in reducing postoperative pain in various surgeries.
  • Its efficacy in patients undergoing total knee arthroplasty (TKA) with spinal anesthesia is not well-established.
  • This study investigates ketamine's role in managing pain after TKA.

Purpose of the Study:

  • To determine the effectiveness of subanesthetic ketamine dosing during TKA.
  • To assess the impact on postoperative pain scores and narcotic consumption.
  • To evaluate ketamine's role within a multimodal pain management strategy.

Main Methods:

  • A prospective, randomized, double-blinded clinical trial involving 91 patients undergoing primary TKA.
  • Patients received either an intraoperative ketamine infusion or a saline placebo.
  • Pain scores and narcotic consumption were recorded at multiple time points post-surgery.

Main Results:

  • No significant difference in average pain scores between ketamine and placebo groups, except at postoperative days 1 and 4.
  • Ketamine group showed reduced least pain experienced only at postoperative day 4.
  • No significant difference in maximum pain or in-hospital morphine equivalents was observed.

Conclusions:

  • Intraoperative ketamine, as part of a multimodal pain management protocol, did not provide clinically significant pain relief after TKA.
  • The study suggests ketamine may not be a beneficial addition for pain and narcotic reduction in this patient population.
  • Further research may explore alternative applications or patient subgroups for ketamine's analgesic effects.