Perioperative ketamine for acute analgesia and beyond

Open access

Abstract

There has been substantial interest in the use of ketamine for perioperative analgesia. Recently published articles on ‘low dose’ ketamine mark the resurgence in interest in the use of the drug for acute pain. Continued interest in ketamine as an anti-depressant also has opened the door to applications beyond the operating room. In this article, we will review: the history of ketamine’s clinical use; basic ketamine pharmacology; evidence for the use of perioperative ketamine for analgesia; comments on patient selection for ketamine research; a discussion of the safety and side effect profile of ketamine infusions beyond the operating room; and, lastly, ketamine as a treatment option for psychiatric diseases.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Domino EF Chodoff P Corssen G. Pharmacologic effects of CI-581 a new dissociative anesthetic in man. Clin Pharmacol Ther 1965; 6: 279-291. doi: 10.1002/cpt196563279

  • 2. Domino EF. Taming the ketamine tiger. Anesthesiology 2010; 113: 678-684. doi: 10.1097/ALN.0b013e3181ed09a2

  • 3. Joly V Richebe P Guignard B Fletcher D Maurette P Sessler DI et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103: 147-155. doi: 10.1097/00000542-200507000-00022

  • 4. Adams JD JR Baillie TA Trevor AJ Castagnoli N Jr. Studies on the biotransformation of ketamine: 1. Identification of metabolites produced in vitro from rat liver microsomal preparations. Bio Mass Spectrom 1981; 8: 527-538. doi: 10.1002/bms.1200081103

  • 5. Leung LY Baillie TA. Comparative pharmacology in the rat of ketamine and its two principal metabolites norketamine and (Z)-6-hydroxynorketamine. J Med Chem 1986; 29: 2396-2399. doi: 10.1021/jm00161a043

  • 6. Zhao X Venkata SL Moaddel R Luckenbaugh DA Brutsche NE Ibrahim L et al. Simultaneous population pharmacokinetic modelling of ketamine and three major metabolites in patients with treatment-resistant bipolar depression. Br J Clin Pharmacol 2012; 74: 304-314. doi: 10.1111/j.1365-2125.2012.04198.x

  • 7. Zarate CA JR Brutsche N Laje G Luckenbaugh DA Venkata SL Ramamoorthy A et al. Relationship of ketamine’s plasma metabolites with response diagnosis and side effects in major depression. Biol Psychiatry 2012; 72: 331-338. doi: 10.1016/j.biopsych.2012.03.004

  • 8. Moaddel R Venkata SL Tanga MJ Bupp JE Green CE Iyer L et al. A parallel chiral-achiral liquid chromatographic method for the determination of the stereoisomers of ketamine and ketamine metabolites in the plasma and urine of patients with complex regional pain syndrome. Talanta 2010; 82: 1892-1904. doi: 10.1016/j.talanta.2010.08.005

  • 9. Zanos P Moaddel R Morris PJ Georgiou P Fischell J Elmer GI et al. NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature 2016; 533: 481-486. doi: 10.1038/nature17998

  • 10. Réus GZ Quevedo J Rodrigues ALS. mTOR signaling in the neuropathophysiology of depression: current evidence. J Receptor Ligand Channel Res 2015; 8: 65-74. doi: 10.2147/JRLCR.S70351

  • 11. Loftus RW Yeager MP Clark JA Brown JR Abdu WA Sengupta DK et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology 2010; 113: 639-646. doi: 10.1097/ALN.0b013e3181e90914

  • 12. Pacreu S Fernández Candil J Moltó L Carazo J Fernández Galinski S. The perioperative combination of methadone and ketamine reduces post-operative opioid usage compared with methadone alone. Acta Anaesthesiol Scand 2012; 56: 1250-1256. doi: 10.1111/j.1399-6576.2012.02743.x

  • 13. Aveline C Hetet HL Vautier P Gautier JF Bonnet F et al. Peroperative [sic] ketamine and morphine for postoperative pain control after lumbar disk surgery. Eur J Pain 2006; 10: 653-658. doi: 10.1016/j.ejpain.2005.10.005

  • 14. Remerand F Le Tendre C Baud A Couvret C Pourrat X Favard L et al. The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective randomized controlled double-blind study. Anesth Analg 2009; 109: 1963-1971. doi: 10.1213/ANE.0b013e3181bdc8a0

  • 15. Martinez V Cymerman A Ben Ammar S Fiaud JF Rapon C Poindessous F et al. The analgesic efficiency of combined pregabalin and ketamine for total hip arthroplasty: a randomized double-blind controlled study. Anaesthesia 2014; 69: 46-52. doi: 10.1111/anae.12495

  • 16. Adam F Chauvin M Du Manoir B Langlois M Sessler DI Fletcher D. Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty. Anesth Analg 2005; 100: 475-480. doi: 10.1213/01.ANE.0000142117.82241.DC

  • 17. Laskowski K Stirling A McKay WP Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth 2011; 58: 911-923. doi: 10.1007/s12630-011-9560-0

  • 18. Bell RF Dahl JB Moore RA Kalso EA. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev 2006; (1): CD004603. doi: 10.1002/14651858.CD004603.pub2

  • 19. Schwenk ES Goldberg SF Patel RD Zhou J Adams DR Baratta JL et al. Adverse drug effects and preoperative medication factors related to perioperative low-dose ketamine infusions. Reg Anesth Pain Med 2016; 41: 482-487. doi: 10.1097/AAP.0000000000000416

  • 20. Himmelseher S Durieux ME. Ketamine for perioperative pain management. Anesthesiology 2005; 102: 211-220

  • 21. Goldberg ME Torjman MC Schwartzman RJ Mager DE Wainer IW. Pharmacodynamic profiles of ketamine (R)- and (S)- with 5-day inpatient infusion for the treatment of complex regional pain syndrome. Pain Physician 2010; 13: 379-387

  • 22. Porter SB McClain RL Howe BL Ardon AE Mazer LS Knestrick BM et al. Perioperative ketamine for acute postoperative analgesia: the Mayo Clinic – Florida experience. J Perianesth Nurs 2015; 30: 189-195. doi: 10.1016/j.jopan.2015.01.010

  • 23. Murrough JW Iosifescu DV Chang LC Al Jurdi RK Green CE Perez AM et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry 2013; 170: 1134-1142. doi: 10.1176/appi.ajp.2013.13030392

  • 24. Murrough JW Burdick KE Levitch CF Perez AM Brallier JW Chang LC et al. Neurocognitive effects of ketamine and association with antidepressant response in individuals with treatment-resistant depression: a randomized controlled trial. Neuropsychopharmacology 2015; 40: 1084-1090. doi: 10.1038/npp.2014.298

  • 25. Wan LB Levitch CF Perez AM Brallier JW Iosifescu DV Chang LC et al. Ketamine safety and tolerability in clinical trials for treatment-resistant depression. J Clin Psychiatry 2015; 76: 247-252. doi: 10.4088/JCP.13m08852

  • 26. Feder A Parides MK Murrough JW Perez AM Morgan JE Saxena S et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry 2014; 7: 681-688. doi: 10.1001/jamapsychiatry.2014.62

  • 27. Murrough JW Soleimani L DeWilde KE Collins KA Lapidus KA Iacoviello BM et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med 2015; 45: 3571-3580. doi: 10.1017/S0033291715001506

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 77 77 6
PDF Downloads 39 39 4