Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Eur J Pain. 2020 Mar;24(3):555-567. doi: 10.1002/ejp.1507. Epub 2019 Dec 9.
Chronic pain after major lower back surgery is frequent. We investigated in adults the effect of perioperative low-dose ketamine on neuropathic lower back pain, assessed by the DN4 questionnaire, 6 and 12 months after major lower back surgery.
In this single-centre randomized trial, 80 patients received intravenous ketamine 0.25 mg/kg preoperatively, followed by 0.25 mg kg hr intraoperatively, and 0.1 mg kg hr from 1 hr before the end of surgery until the end of recovery room stay; 80 controls received placebo.
Preoperatively, 47.4% of patients in the ketamine group and 46.3% in the placebo group had neuropathic pain; 10% and 3.8%, respectively, were using strong opioids. At the end of the infusion, the median cumulative dose of ketamine was 84.8 mg (IQR 67.4-106.7) and the median plasma level was 97 ng/ml (IQR 77.9-128.0). At 6 months, 28.8% of patients in the ketamine group and 23.5% in the placebo group had neuropathic pain (absolute difference, 5.2%; 95% CI -10.7 to 21.1; p = .607). At 12 months, 26.4% of patients in the ketamine group and 17.9% in the placebo group had neuropathic pain (absolute difference 8.5%; 95% CI -6.7 to 23.6; p = .319).
In this patient population with a high prevalence of neuropathic lower back pain undergoing major lower back surgery, a perioperative intravenous low-dose ketamine infusion did not have an effect on the prevalence of neuropathic lower back pain at 6 or 12 months postoperatively.
We were unable to show any analgesic benefit of a short-term perioperative ketamine infusion as an adjuvant to multimodal analgesia in patients with a high prevalence of neuropathic lower back pain undergoing major back surgery. Based on these data, the widespread opinion that ketamine is universally analgesic across different pain conditions must be challenged.
Abstract presentation at the annual congress of the Swiss Society of Anaesthesiology, 2016, Basel, Switzerland.
Registered by Dr Christoph Czarnetzki as principal investigator on February 20, 2008 at clinicaltrials.gov (NCT00618423).
大手术后慢性下腰痛很常见。我们研究了成年人围手术期低剂量氯胺酮对大下腰痛术后神经病理性疼痛的影响，使用 DN4 问卷在术后 6 和 12 个月进行评估。
在这项单中心随机试验中，80 名患者在术前接受静脉注射氯胺酮 0.25mg/kg，术中给予 0.25mg/kg/hr，从手术结束前 1 小时至恢复室结束时给予 0.1mg/kg/hr；80 名对照组给予安慰剂。
术前，氯胺酮组 47.4%的患者和安慰剂组 46.3%的患者有神经病理性疼痛；分别有 10%和 3.8%的患者正在使用强阿片类药物。输注结束时，氯胺酮的累积剂量中位数为 84.8mg（IQR 67.4-106.7），血浆水平中位数为 97ng/ml（IQR 77.9-128.0）。术后 6 个月，氯胺酮组 28.8%的患者和安慰剂组 23.5%的患者有神经病理性疼痛（绝对差异 5.2%；95%CI-10.7 至 21.1；p=0.607）。术后 12 个月，氯胺酮组 26.4%的患者和安慰剂组 17.9%的患者有神经病理性疼痛（绝对差异 8.5%；95%CI-6.7 至 23.6；p=0.319）。
在这群大下腰痛手术、术后神经病理性腰痛发生率较高的患者中，围手术期静脉内给予低剂量氯胺酮对术后 6 或 12 个月时神经病理性腰痛的发生率没有影响。
我们未能证明短期围手术期氯胺酮输注作为多模式镇痛的辅助治疗在大下腰痛手术、术后神经病理性腰痛发生率较高的患者中有任何镇痛益处。基于这些数据，必须对氯胺酮在不同疼痛情况下普遍具有镇痛作用的普遍观点提出质疑。
2016 年在瑞士麻醉学会年会上进行了摘要汇报，地点为瑞士巴塞尔。
由 Christoph Czarnetzki 医生于 2008 年 2 月 20 日作为主要研究者在 clinicaltrials.gov 上注册（NCT00618423）。
