The development of new, multimodal approaches for pain management has been a key part of the movement called enhanced recovery after surgery, or ERAS. Overreliance on opioid medications goes against the goals of ERAS, as it can slow the return to normal diet and walking and delay hospital discharge.
Ketamine is a medication with potent pain-relieving properties that works by blocking specific receptors in the nervous system. Because it can reduce the need for opioids, it’s been used for pain control under ERAS protocols. However, recent research suggests this may not be a good idea.
A double-blind, placebo-controlled, randomized trial at Vanderbilt University Medical Center, reported in the British Journal of Anaesthesia, studied 1,522 adults undergoing abdominal surgery. Patients were randomly assigned to receive either ketamine or saline placebo at the start of general anesthesia, followed by an infusion of these same substances during and after surgery for up to 48 hours.
Compared to placebo, ketamine didn’t reduce opioid use or shorten hospital stays. In fact, patients receiving ketamine were twice as likely to be transferred to intensive care, six times as likely to experience severe dizziness, more than two-and-a-half times as likely to have severe hallucinations, and twice as likely to have other severe side effects. The study adds to growing evidence that ketamine may not be a good choice for expediting recovery after surgery.
The trial was led by the report’s lead author, Britany Raymond, MD (now Britany Martin), assistant professor of Anesthesiology, and senior authors Todd Rice, MD, MSCI, professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine, and Miklos Kertai, MD, MMHC, PhD, professor of Anesthesiology. Others on the study include Brian Allen, MD, Robert Freundlich, MD, MS, MSCI, Matthew McEvoy, MD, Crystal Parrish, MSN, Sydney Ruble, MSN, RN, Kevin Scharfman, PharmD, Jonathan Wanderer, MD, MPhil, Yue Gao, MS, Leena Choi, PhD, and Mary Lynn Dear, PhD. The trial was supported by the Vanderbilt Center for Learning Healthcare through National Institutes of Health Award UL1TR002243.
