Continuous Intravenous Ketamine for Pain Control After Tibial or Femoral Osteotomy

Area of Science:

• Orthopedic Surgery
• Pain Management
• Anesthesiology

Background:

• High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are orthopedic procedures often associated with significant postoperative pain.
• Effective pain management is crucial for patient recovery and early discharge after these procedures.
• Opioid analgesics are commonly used but carry risks of side effects and dependence.

Purpose of the Study:

• To evaluate the efficacy of continuous intravenous ketamine as part of a multimodal pain strategy.
• To assess the potential of this approach in reducing opioid requirements after HTO and DFO.
• To determine the safety and effectiveness of this novel pain pathway.

Main Methods:

• A case series involving four patients who underwent HTO or DFO.
• Administration of continuous intravenous ketamine as part of a multimodal pain regimen.
• Postoperative pain intensity was measured using the Numerical Rating Scale and analyzed as the area under the curve (AUC).

Main Results:

• All four patients experienced low average pain scores (1.1-4.4/10).
• Patients had varying AUC pain scores, indicating manageable pain levels.
• All patients were discharged on postoperative day 1, suggesting successful pain control and recovery.

Conclusions:

• A perioperative pain pathway incorporating continuous low-dose ketamine infusion and non-opioid adjuncts is effective for pain management.
• This multimodal strategy shows promise in managing pain after knee periarticular osteotomies.
• The approach facilitates early discharge, highlighting its clinical utility.