Lloyd-Donald Patryck J, Peyton Philip J
Department of Anaesthesia, Austin Health, Victoria 3084, Australia.
Department of Critical Care, University of Melbourne, Victoria 3050, Australia.
Anaesth Intensive Care. 2025 May;53(3):190-198. doi: 10.1177/0310057X241309655. Epub 2025 Feb 12.
Ketamine is an N-methyl-d-aspartate receptor antagonist approved for use in anaesthesia, with analgesic properties. Despite publication of numerous trials and expert guidelines on its use for pain management, administration of ketamine as part of multimodal perioperative analgesia remains 'off-label'. We conducted an online, prospective survey of ANZCA Fellows, exploring current prescribing practices of intravenous ketamine for perioperative analgesia. We surveyed 2000 Fellows and received 806 responses. The factors mostly likely to influence their administration of perioperative ketamine included pre-existing chronic pain, and heavy or multiple opioid use by patients preoperatively. Amongst respondents, less senior anaesthetists and those working in public hospitals were more likely to administer intraoperative ketamine. The surgical procedures most likely to result in ketamine administration intraoperatively were open pelvic/abdominal, thoracic and major spinal surgery, where ketamine administration was likely practice for the majority of respondents, with typical loading doses that ranged widely. The commonest choices of intraoperative loading dose were between 0.2 mg kg and 0.6 mg kg. The commonest choice of intraoperative and postoperative infusion rate was in the range of 0.1-0.2 mg kg h. Postoperative ketamine infusion was most commonly prescribed as third-line or rescue analgesia. The majority of respondents thought it either 'likely' or 'very likely' ketamine would reduce postoperative chronic pain after thoracic surgery, but not in other surgical categories. Our findings suggest that off-label perioperative administration of ketamine at analgesic dose ranges is routine or common practice in major surgery for a majority of specialist anaesthetists in Australia and New Zealand.
氯胺酮是一种已被批准用于麻醉的N-甲基-D-天冬氨酸受体拮抗剂，具有镇痛特性。尽管已发表了大量关于其用于疼痛管理的试验和专家指南，但氯胺酮作为多模式围手术期镇痛的一部分进行给药仍属于“超说明书用药”。我们对澳大利亚和新西兰麻醉学院会员进行了一项在线前瞻性调查，探讨静脉注射氯胺酮用于围手术期镇痛的当前处方实践。我们调查了2000名会员，收到了806份回复。最有可能影响他们围手术期氯胺酮给药的因素包括患者术前已存在的慢性疼痛以及大量或多种阿片类药物的使用。在受访者中，资历较浅的麻醉医生以及在公立医院工作的医生更有可能在术中使用氯胺酮。术中最有可能导致使用氯胺酮的外科手术是开放性盆腔/腹部、胸部和大型脊柱手术，大多数受访者在这些手术中可能会使用氯胺酮，典型的负荷剂量范围很广。术中负荷剂量最常见的选择是在0.2毫克/千克至0.6毫克/千克之间。术中及术后输注速率最常见的选择范围是0.1 - 0.2毫克/千克·小时。术后氯胺酮输注最常被开为三线或挽救性镇痛药物。大多数受访者认为氯胺酮“可能”或“非常可能”会减轻胸外科手术后的慢性疼痛，但在其他手术类别中则不然。我们的研究结果表明，对于澳大利亚和新西兰的大多数专科麻醉医生来说，在大手术中以镇痛剂量范围进行氯胺酮超说明书围手术期给药是常规或常见做法。
