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Effect of S-ketamine on postoperative pain sensitivity in children with preoperative chemotherapy
Siyi Zhou1, Yong Bian1, Kan Zhang1
1Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
Insights
Intravenous S-ketamine significantly improved postoperative pain control in children receiving chemotherapy. This treatment increased pain thresholds and reduced pain scores, offering a promising approach for managing pain in this vulnerable group.
Area of Science:
- Pediatric Anesthesiology
- Oncology Supportive Care
- Pain Management
Background:
- Children undergoing chemotherapy often experience heightened postoperative pain.
- The effectiveness of S-ketamine in reducing chemotherapy-induced hyperalgesia is not well-established.
- This study addresses the need to evaluate S-ketamine's impact on pain sensitivity in pediatric patients pre-treated with chemotherapy.
Purpose of the Study:
- To assess the efficacy of intraoperative intravenous S-ketamine in mitigating postoperative pain.
- To determine the effect of S-ketamine on pain sensitivity in children who received neoadjuvant chemotherapy.
- To investigate S-ketamine's role in managing chemotherapy-induced hyperalgesia.
Main Methods:
- A randomized controlled trial involving 40 children scheduled for open abdominal surgery after preoperative chemotherapy.
- Patients were assigned to either an S-ketamine or a control group.
- Primary outcomes included postoperative mechanical pain threshold, FLACC scale, Wong-Baker FACES scale (WBS), and analgesic use.
Main Results:
- S-ketamine administration led to significantly higher mechanical pain thresholds at 24 and 48 hours post-surgery.
- Postoperative pain scores (FLACC and WBS) were significantly lower in the S-ketamine group.
- A negative correlation was observed between S-ketamine infusion time and postoperative pain thresholds.
Conclusions:
- Intravenous S-ketamine effectively increases postoperative mechanical pain threshold in children who received neoadjuvant chemotherapy.
- S-ketamine administration significantly reduces postoperative pain in this patient population.
- S-ketamine shows potential as an intervention to improve postoperative pain outcomes in pediatric cancer patients.
Background:
Children undergoing chemotherapy experience exacerbated postoperative pain and prolonged pain perception. Intraoperative intravenous administration of S-ketamine can alleviate postoperative pain. However, its efficacy in mitigating chemotherapy-induced hyperalgesia remains uncertain. This study evaluates the effect of S-ketamine on postoperative pain sensitivity in children who received preoperative chemotherapy.
Methods:
A total of 40 children undergoing preoperative chemotherapy and scheduled for open abdominal surgery were recruited from our center and randomly assigned to either the S-ketamine group or the control group. The primary outcomes included postoperative mechanical pain threshold, FLACC scale, Wong-Baker FACES pain rating scale (WBS), and cases of additional analgesic use. Secondary outcomes included intraoperative hemodynamic changes, extubation time, and incidence of adverse events.
Results:
Thirty-six children were included in the study. The two groups had no significant difference in preoperative mechanical pain thresholds (P = 0.585). Patients receiving S-ketamine had higher mechanical pain thresholds at 24 and 48 h post-surgery (both P < 0.001). Preoperative FLACC and WBS were 0 in both groups. Postoperative FLACC and WBS showed significant differences at various time points (all P < 0.05). There is a negative correlation between infusion time of S-ketamine and postoperative mechanical pain threshold at 24 h (r = -0.570, P = 0.014) and 48 h postoperatively (r = -0.643, P = 0.004) in the S-ketmanie group.
Conclusion:
Intravenous S-ketamine significantly increases postoperative mechanical pain threshold and reduces pain in patients who received neoadjuvant chemotherapy.
Impact:
Children undergoing chemotherapy experience exacerbated postoperative pain and prolonged pain perception. Intraoperative intravenous administration of S-ketamine can alleviate postoperative pain. However, its efficacy in mitigating chemotherapy-induced hyperalgesia remains uncertain. This study fills the gap in this area. This study evaluates the effect of S-ketamine on postoperative pain sensitivity in children who received preoperative chemotherapy. S-ketamine's NMDAR antagonism may partly reduce pain sensitivity, thus reversing the pain effect. The results of this study provide promising evidence for the potential benefits of S-ketamine in improving postoperative pain outcomes in this patient population. The infusion time of S-ketamine ranged from 30 to 655 min, suggesting that the beneficial effect can be achieved within this time frame.
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