S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery : A randomized, double-blind, placebo-controlled clinical trial

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Brinck , E C V , Virtanen , T , Mäkelä , S , Soini , V , Hynninen , V-V , Mulo , J , Savolainen , U , Rantakokko , J , Maisniemi , K , Liukas , A , Olkkola , K T , Kontinen , V , Tarkkila , P , Peltoniemi , M & Saari , T I 2021 , ' S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery : A randomized, double-blind, placebo-controlled clinical trial ' , PLoS One , vol. 16 , no. 6 , 0252626 . https://doi.org/10.1371/journal.pone.0252626

Title: S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery : A randomized, double-blind, placebo-controlled clinical trial
Author: Brinck, Elina C. V.; Virtanen, Taru; Mäkelä, Sanna; Soini, Venla; Hynninen, Ville-Veikko; Mulo, Jukka; Savolainen, Urmas; Rantakokko, Juho; Maisniemi, Kreu; Liukas, Antti; Olkkola, Klaus T.; Kontinen, Vesa; Tarkkila, Pekka; Peltoniemi, Marko; Saari, Teijo I.
Contributor: University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
Date: 2021-06-07
Language: eng
Number of pages: 16
Belongs to series: PLoS One
ISSN: 1932-6203
URI: http://hdl.handle.net/10138/333959
Abstract: Background Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown. Methods We randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml-1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery. Results Of the 100 patients analyzed, patients receiving 0.75 mg ml(-1) S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml(-1) (74.7 mg) or 0.25 mg ml(-1) (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: -20.6 mg; 95% confidence interval [CI]: -41 to -0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml(-1) S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013-0.32, P = 0.033). The occurrence of adverse events was similar among the groups. Conclusions Oxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.
Subject: ACUTE POSTOPERATIVE PAIN
ADDING KETAMINE
MORPHINE
PHARMACODYNAMICS
PHARMACOKINETICS
COMBINATION
RISK
AGE
3126 Surgery, anesthesiology, intensive care, radiology
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