Analgesic Efficacy of Intravenous Ketamine as a Continuous Infusion vs PCA in the Management of Acute Postoperative Pain in Major Orthopedic Surgery.

Summary

The goal of this clinical trial is to determine whether treating pain after surgery with ketamine is more effective when administered intravenously as a continuous infusion or through a patient-controlled analgesia (PCA) pump. This study focuses on adult volunteers following major orthopedic surgery. We have two main questions to address: * Is a continuous intravenous infusion of ketamine as effective as ketamine administered through a PCA pump for managing pain after major orthopedic surgery. * Does a continuous intravenous infusion of ketamine result in lower opioid requirements compared to ketamine delivered through a PCA pump for pain management after major orthopedic surgery? Participants will be divided into two groups. One group will receive ketamine via continuous infusion, while the other will receive it through a PCA pump. Both groups will also receive a placebo (a substance that looks like the drug but contains no active ingredients), ensuring that neither group knows whether they are receiving ketamine through the PCA pump (which always contains a painkiller) or as a continuous infusion. Participants will be assigned to one of the two groups and will receive their assigned treatment for 48 hours while hospitalized. Researchers will visit participants during their first three days in the hospital to assess their pain levels and monitor for any side effects.

Timeline

Start

2025-03-01

Primary completion

2026-03-30

Completion

2027-06-15

Publications

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• Background Waelkens P, Alsabbagh E, Sauter A, Joshi GP, Beloeil H; PROSPECT Working group * * of the European Society of Regional Anaesthesia and Pain therapy (ESRA). Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations. Eur J Anaesthesiol. 2021 Sep 1;38(9):985-994. doi: 10.1097/EJA.0000000000001448.
• Background Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018 Jul;43(5):456-466. doi: 10.1097/AAP.0000000000000806.
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• Background Meyer-Friessem CH, Lipke E, Weibel S, Kranke P, Reichl S, Pogatzki-Zahn EM, Zahn PK, Schnabel A. Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: A systematic review and meta-analysis. J Clin Anesth. 2022 Jun;78:110652. doi: 10.1016/j.jclinane.2022.110652. Epub 2022 Jan 19.
• Background Xu L, Xu S, Zhang Y, Huang Y. Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta-analysis. Brain Behav. 2023 Aug;13(8):e3149. doi: 10.1002/brb3.3149. Epub 2023 Jul 11.
• Background Sun W, Zhou Y, Wang J, Fu Y, Fan J, Cui Y, Wu Y, Wang L, Yu Y, Han R. Effects of Ketamine on Chronic Postsurgical Pain in Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Pain Physician. 2023 May;26(3):E111-E122.
• Background Aguirre-Cadavid LF, Ramírez-Luján CD, Casas-Arroyave FD, Calle-Cadavid E, Camelo-Rincón JE, Cadavid-Puentes AM. Psychomimetic Effects of Low-Dose Ketamine Infusions in Postoperative Pain: A Cohort Study.
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• Background Cadavid-Puentes AM, Camelo Rincón JE, Casas Arroyave FD, Chávez Lasso EF, Leyton Ortega M, Tovar Gutiérrez A. Hemodynamic response to sub-anesthetic doses of ketamine for postoperative pain: systematic review. Colomb J Anesthesiol. Available since february 12, 2024 52(2).
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• Background Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013 Apr;118(4):934-44. doi: 10.1097/ALN.0b013e31828866b3.
• Background Hannon CP, Fillingham YA, Gililland JM, Sporer SM, Casambre FD, Verity TJ, Woznica A, Nelson N, Hamilton WG, Della Valle CJ. A Systematic Review of the Efficacy and Safety of Ketamine in Total Joint Arthroplasty. J Arthroplasty. 2023 Apr;38(4):763-768.e2. doi: 10.1016/j.arth.2022.10.037. Epub 2022 Oct 31.
• Background Zhou L, Yang H, Hai Y, Cheng Y. Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Res Manag. 2022 Mar 31;2022:1507097. doi: 10.1155/2022/1507097. eCollection 2022.
• Background Pendi A, Field R, Farhan SD, Eichler M, Bederman SS. Perioperative Ketamine for Analgesia in Spine Surgery: A Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976). 2018 Mar 1;43(5):E299-E307. doi: 10.1097/BRS.0000000000002318.
• Background Terracina S, Robba C, Prete A, Sergi PG, Bilotta F. Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review. Pain Pract. 2018 Sep;18(7):925-945. doi: 10.1111/papr.12684. Epub 2018 Mar 25.
• Background Zhaksylyk A, Abdildin YG, Sultangazin S, Zhumakanova A, Viderman D. The impact of ketamine on pain-related outcomes after thoracotomy: a systematic review with meta-analysis of randomized controlled trials. Front Med (Lausanne). 2024 Jun 11;11:1394219. doi: 10.3389/fmed.2024.1394219. eCollection 2024.
• Background Akram U, Nadeem ZA, Ashfaq H, Fatima E, Ashraf H, Raza MA, Ahmed S, Nadeem A, Rehman S, Ahmad MH. Intraoperative ketamine and pain after video-assisted thoracoscopic surgery (VATS): A systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2024 Dec;43(6):101444. doi: 10.1016/j.accpm.2024.101444. Epub 2024 Oct 16.
• Background Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018 Dec 20;12(12):CD012033. doi: 10.1002/14651858.CD012033.pub4.
• Background Garcia-Henares JF, Moral-Munoz JA, Salazar A, Del Pozo E. Effects of Ketamine on Postoperative Pain After Remifentanil-Based Anesthesia for Major and Minor Surgery in Adults: A Systematic Review and Meta-Analysis. Front Pharmacol. 2018 Aug 17;9:921. doi: 10.3389/fphar.2018.00921. eCollection 2018.
• Background Wang L, Johnston B, Kaushal A, Cheng D, Zhu F, Martin J. Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials. Can J Anaesth. 2016 Mar;63(3):311-25. doi: 10.1007/s12630-015-0551-4. Epub 2015 Dec 10.
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• Background Levy N, Quinlan J, El-Boghdadly K, Fawcett WJ, Agarwal V, Bastable RB, Cox FJ, de Boer HD, Dowdy SC, Hattingh K, Knaggs RD, Mariano ER, Pelosi P, Scott MJ, Lobo DN, Macintyre PE. An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia. 2021 Apr;76(4):520-536. doi: 10.1111/anae.15262. Epub 2020 Oct 7.
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• Background Nardi-Hiebl S, Eberhart LHJ, Gehling M, Koch T, Schlesinger T, Kranke P. Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia. Anesthesiol Res Pract. 2020 Feb 13;2020:9201967. doi: 10.1155/2020/9201967. eCollection 2020.
• Background Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017 Sep 25;10:2287-2298. doi: 10.2147/JPR.S144066. eCollection 2017.
• Background Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013 Jan 8;346:e7586. doi: 10.1136/bmj.e7586.

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Indications