Rothman Orthopaedic Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA.
Rothman Orthopaedic Institute, Bryn Mawr Hospital, Bryn Mawr, PA.
J Arthroplasty. 2019 Aug;34(8):1640-1645. doi: 10.1016/j.arth.2019.04.017. Epub 2019 Apr 12.
Multiple studies have demonstrated that ketamine, a glutamate receptor blocker, may decrease postoperative pain in abdominal and orthopedic surgeries. However, its role with spinal anesthesia and total knee arthroplasty (TKA) remains unknown. The purpose of this study is to determine the efficacy of subanesthetic dosing of ketamine during TKA on postoperative pain and narcotic consumption.
In this prospective, randomized, double-blinded clinical trial, we enrolled 91 patients undergoing primary TKA with spinal anesthesia in a single institution from 2017 to 2018. Patients were randomized to receive intraoperative ketamine infusion at a rate of 6 mcg/kg/min for 75 minutes or a saline placebo. All patients received spinal anesthesia and otherwise identical surgical approaches, pain management, and rehabilitation protocols. Patient-reported visual analog pain scores were calculated preoperatively, postoperative days (POD) 0-7, and 2 weeks. Narcotic consumption was evaluated on POD 0 and 1.
There was no difference in average pain between ketamine and placebo at all time points except for at PODs 1 (45 vs 56, P = .041) and 4 (39 vs 49, P = .040). For least pain experienced, patients administered with ketamine experienced a reduction in pain only at POD 4 (22 vs 35, P = .011). There was no difference in maximum pain cohorts at all time points of the study or in-hospital morphine equivalents between the 2 cohorts.
As part of multimodal pain management protocol, intraoperative ketamine does not result in a clinically significant improvement in pain and narcotic consumption following TKA.
多项研究表明，谷氨酸受体阻滞剂氯胺酮可能会降低腹部和骨科手术后的疼痛。然而，其在椎管内麻醉和全膝关节置换术（TKA）中的作用尚不清楚。本研究旨在确定 TKA 中给予亚麻醉剂量氯胺酮对术后疼痛和阿片类药物消耗的疗效。
本前瞻性、随机、双盲临床试验纳入了 2017 年至 2018 年期间在一家机构接受椎管内麻醉下初次 TKA 的 91 例患者。患者随机接受术中氯胺酮输注，速度为 6 mcg/kg/min，持续 75 分钟，或生理盐水安慰剂。所有患者均接受椎管内麻醉和相同的手术入路、疼痛管理和康复方案。术前、术后第 0-7 天和第 2 周计算患者报告的视觉模拟疼痛评分。术后第 0 和 1 天评估阿片类药物消耗量。
除术后第 1 天（45 比 56，P =.041）和第 4 天（39 比 49，P =.040）外，氯胺酮组和安慰剂组在所有时间点的平均疼痛均无差异。在最低疼痛体验方面，只有在术后第 4 天（22 比 35，P =.011），接受氯胺酮治疗的患者疼痛减轻。在研究的所有时间点或两组之间的住院吗啡等效物方面，最大疼痛组之间均无差异。
作为多模式疼痛管理方案的一部分，TKA 术中给予氯胺酮不能显著改善术后疼痛和阿片类药物消耗。
