Park Paul J, Makhni Melvin C, Cerpa Meghan, Lehman Ronald A, Lenke Lawrence G
Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, USA.
Department of Orthopedic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
J Spine Surg. 2020 Sep;6(3):591-597. doi: 10.21037/jss-19-306.
Opioid abuse has rapidly developed into an epidemic across the United States. Patients are often introduced to opioids following surgical procedures-this is particularly relevant following spinal surgery. Surgeons can help reduce this opioid burden by finding alternatives to narcotic analgesia in the postoperative period. One such medication that has shown potential in this role is ketamine, which has been studied in various surgical specialties. A review was performed of current literature regarding ketamine use in the perioperative period specific to spinal surgery. This review focused on prospective randomized control trials; the primary endpoint was opioid consumption in the postoperative period, monitored through patient-controlled analgesia (PCA) use. Both pediatric and adult spinal surgery patients were included; cervical, thoracic, and lumbar procedures were also all included. 10 studies were selected for this reviewed based on inclusion criteria, published between 2004 and 2017. 7 of these studies demonstrated a significant decrease in postoperative opioid use with the integration of ketamine in the perioperative period, while 3 trials showed no significant difference in opioid consumption. There is inherent difficulty in standardizing studies of this nature-dosing protocols, medication timing, and supplemental analgesia were variable throughout the included studies. However, this review of the most up-to-date prospective studies indicate ketamine has potential to play a significant role in reducing opioid requirements following spinal surgery, and further study is warranted in this field.
阿片类药物滥用在美国已迅速发展成为一种流行病。患者常在外科手术后开始使用阿片类药物，脊柱手术后尤其如此。外科医生可通过在术后找到麻醉镇痛的替代方法来减轻这种阿片类药物负担。氯胺酮就是一种在这方面显示出潜力的药物，它已在多个外科专业中得到研究。我们对目前关于氯胺酮在脊柱手术围手术期使用的文献进行了综述。本综述聚焦于前瞻性随机对照试验；主要终点是术后通过患者自控镇痛（PCA）使用情况监测的阿片类药物消耗量。纳入了儿科和成人脊柱手术患者；颈椎、胸椎和腰椎手术也均有涉及。根据纳入标准，选取了2004年至2017年间发表的10项研究进行本综述。其中7项研究表明，围手术期使用氯胺酮可使术后阿片类药物使用量显著减少，而3项试验显示阿片类药物消耗量无显著差异。对这类研究进行标准化存在内在困难，在所纳入的研究中，给药方案、用药时间和辅助镇痛方法各不相同。然而，对这些最新前瞻性研究的综述表明，氯胺酮在减少脊柱手术后的阿片类药物需求方面有潜力发挥重要作用，该领域值得进一步研究。
