Opioid-sparing by low-dose ketamine for endometriosis surgery. A single-center, prospective, randomized, trial

Endometriosis affects 10% of women of childbearing age and 25-50% of infertile women worldwide. Although most patients with endometriosis are completely asymptomatic, there is still a significant proportion of patients, whose quality of life is impaired by the disease, resulting in chronic pelvic pain. However, there is a poor correlation between objective findings of significant endometriosis and pain severity. Opioids typically form part of a postoperative analgesic regimen. However, opioid tolerance, adverse effects, contraindications, or a combination of these factors may limit their use. As part of the multimodal regime, ketamine may play a critical role for patients undergoing surgery when postoperative pain is expected to be severe. It is most commonly used for acute pain management in settings involving trauma, the exacerbation of chronic painful conditions, and postsurgical pain, particularly in opioid-tolerant patients, generally at subanesthetic doses. Notably, in therapy-refractory pharmacological situations, surgical treatment of endometriosis with intraoperative low-dose ketamine could be helpful and may constitute an effective strategy for limiting disease recurrence. However, it is important to evaluate the significance of ketamine in endometriosis surgery for preventing chronic pain syndrome, which in turn would result in an improvement in the quality of life of patients with endometriosis.Clinical trial registration: www.clinicaltrials.gov identifier is NCT06951802.