scholarly journals Perioperative Methadone and Ketamine for Postoperative Pain Control in Spinal Surgical Patients: A Randomized, Double-blind, Placebo-controlled Trial

2021 ◽  
Vol 134 (5) ◽  
pp. 697-708
Author(s):  
Glenn S. Murphy ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Jessica Benson ◽  
Sara Bilimoria ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Controlled Trial ◽  
Ideal Body Weight ◽  
Postoperative Pain Control ◽  
Double Blind ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pain Scores ◽  
Methadone Group ◽  
Ideal Body

Background Despite application of multimodal pain management strategies, patients undergoing spinal fusion surgery frequently report severe postoperative pain. Methadone and ketamine, which are N-methyl-d-aspartate receptor antagonists, have been documented to facilitate postoperative pain control. This study therefore tested the primary hypothesis that patients recovering from spinal fusion surgery who are given ketamine and methadone use less hydromorphone on the first postoperative day than those give methadone alone. Methods In this randomized, double-blind, placebo-controlled trial, 130 spinal surgery patients were randomized to receive either methadone at 0.2 mg/kg (ideal body weight) intraoperatively and a 5% dextrose in water infusion for 48 h postoperatively (methadone group) or 0.2 mg/kg methadone intraoperatively and a ketamine infusion (0.3 mg · kg−1 · h−1 infusion [no bolus] intraoperatively and then 0.1 mg · kg−1 · h−1 for next 48 h [both medications dosed at ideal body weight]; methadone/ketamine group). Anesthetic care was standardized in all patients. Intravenous hydromorphone use on postoperative day 1 was the primary outcome. Pain scores, intravenous and oral opioid requirements, and patient satisfaction with pain management were assessed for the first 3 postoperative days. Results Median (interquartile range) intravenous hydromorphone requirements were lower in the methadone/ketamine group on postoperative day 1 (2.0 [1.0 to 3.0] vs. 4.6 [3.2 to 6.6] mg in the methadone group, median difference [95% CI] 2.5 [1.8 to 3.3] mg; P < 0.0001) and postoperative day 2. In addition, fewer oral opioid tablets were needed in the methadone/ketamine group on postoperative day 1 (2 [0 to 3] vs. 4 [0 to 8] in the methadone group; P = 0.001) and postoperative day 3. Pain scores at rest, with coughing, and with movement were lower in the methadone/ketamine group at 23 of the 24 assessment times. Patient-reported satisfaction scores were high in both study groups. Conclusions Postoperative analgesia was enhanced by the combination of methadone and ketamine, which act on both N-methyl-d-aspartate and μ-opioid receptors. The combination could be considered in patients having spine surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

302. The efficacy of ketamine for improvement of postoperative pain control in adolescent patients undergoing spinal fusion surgery for idiopathic scoliosis

2019 ◽  
Vol 19 (9) ◽  
pp. S147-S148
Author(s):  
Noah M. Walters ◽  
Ryan M. Ricciardelli ◽  
Maxwill D. Pomerantz ◽  
Benjamin Metcalfe ◽  
Melissa A. Ehlers ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pain Control ◽  
Postoperative Pain Control ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Adolescent Patients

The efficacy of ketamine for postoperative pain control in adolescent patients undergoing spinal fusion surgery for idiopathic scoliosis

2020 ◽  
Vol 8 (3) ◽  
pp. 433-440
Author(s):  
Ryan M. Ricciardelli ◽  
Noah M. Walters ◽  
Maxwill Pomerantz ◽  
Benjamin Metcalfe ◽  
Farzana Afroze ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pain Control ◽  
Postoperative Pain Control ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Adolescent Patients

Long saphenous tunnel infiltration with levobupivicaine reduces rescue analgesia requirements following varicose vein surgery: randomized, double-blind, placebo-controlled trial [ISRCTN58431114]

2007 ◽  
Vol 22 (5) ◽  
pp. 214-218
Author(s):  
S R Walsh ◽  
C Waters ◽  
J Hall ◽  
M Bakar ◽  
J Boyle ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anaesthetic ◽  
Varicose Vein ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Control Group ◽  
Varicose Vein Surgery ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Pain Scores

Objectives: To determine whether local anaesthetic infiltration of the long saphenous tunnel in patients undergoing unilateral, primary long saphenous stripping and multiple avulsions reduces early postoperative pain and requirement for opiate analgesia. Methods: Patients were randomized to receive either levobupivicaine or an equivalent volume of normal saline infiltrated around the groin incision and along the long saphenous tunnel. Analgesia and linear analogue pain scores at 1, 6 and 24 h postoperatively were recorded. Results: Fourteen patients received local anaesthetic and 13 patients received saline placebo. The anaesthetic group experienced a 22% reduction in pain scores 1 h postoperatively and a 48% reduction at 6 h although this failed to achieve statistical significance. However, the anaesthetic group were less likely to require morphine in recovery (2/14 [14%] versus 8/13 [62%]; P = 0.01). The high morphine requirements in the control group may have reduced the amount of pain those patients recorded on their pain scores and prevented statistical significance from being achieved. Conclusion: In varicose vein surgery, local anaesthetic infiltration to the groin wound and along the full length of the stripper track is associated with reduced postoperative pain and requirements for opiate analgesia.

scholarly journals Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Luiz Eduardo de Paula Gomes Miziara ◽  
Ricardo Francisco Simoni ◽  
Luís Otávio Esteves ◽  
Luis Henrique Cangiani ◽  
Gil Fernando Ribeiro Grillo-Filho ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Control ◽  
Controlled Trial ◽  
Intervention Group ◽  
Morphine Consumption ◽  
Postoperative Pain Control ◽  
Intravenous Anesthesia ◽  
Ketamine Infusion ◽  
Pain Scores

Aim.A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control.Methods.Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg−1·h−1(n=24, intervention group) or an equivalent volume of saline at the same rate (n=24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery.Results.Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P=0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200±2.707) than in the placebo group (7.525±1.872).Conclusions.Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement.Trial Registration. This trial is registered with ClinicalTrials.govNCT02421913.

Clinical Effectiveness and Safety of Intraoperative Methadone in Patients Undergoing Posterior Spinal Fusion Surgery

2017 ◽  
Vol 126 (5) ◽  
pp. 822-833 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Spinal Fusion ◽  
Postanesthesia Care Unit ◽  
Anesthetic Care ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pain Scores ◽  
Methadone Group ◽  
Group Randomized Trial

Abstract Background Patients undergoing spinal fusion surgery often experience severe pain during the first three postoperative days. The aim of this parallel-group randomized trial was to assess the effect of the long-duration opioid methadone on postoperative analgesic requirements, pain scores, and patient satisfaction after complex spine surgery. Methods One hundred twenty patients were randomized to receive either methadone 0.2 mg/kg at the start of surgery or hydromorphone 2 mg at surgical closure. Anesthetic care was standardized, and clinicians were blinded to group assignment. The primary outcome was intravenous hydromorphone consumption on postoperative day 1. Pain scores and satisfaction with pain management were measured at postanesthesia care unit admission, 1 and 2 h postadmission, and on the mornings and afternoons of postoperative days 1 to 3. Results One hundred fifteen patients were included in the analysis. Median hydromorphone use was reduced in the methadone group not only on postoperative day 1 (4.56 vs. 9.90 mg) but also on postoperative days 2 (0.60 vs. 3.15 mg) and 3 (0 vs. 0.4 mg; all P< 0.001). Pain scores at rest, with movement, and with coughing were less in the methadone group at 21 of 27 assessments (all P = 0.001 to < 0.0001). Overall satisfaction with pain management was higher in the methadone group than in the hydromorphone group until the morning of postoperative day 3 (all P = 0.001 to < 0.0001). Conclusions Intraoperative methadone administration reduced postoperative opioid requirements, decreased pain scores, and improved patient satisfaction with pain management.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 592-601 ◽  
Author(s):  
Arpan A Patel ◽  
Corey T Walker ◽  
Virginia Prendergast ◽  
John J Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pain Scores ◽  
High Consumption ◽  
Lumbar Spinal

Abstract BACKGROUND Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion. OBJECTIVE To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices. METHODS A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients were divided into cohorts on the basis of postoperative treatment with PCA or NCA. Postoperative pain scores, length of stay, and total opioid consumption data were collected. Patients were stratified according to preoperative opioid consumption as opioid naive (0 morphine milligram equivalents [MME] daily), low consumption (1-60 MME), high consumption (61-90 MME), or very high consumption (>90 MME). RESULTS A total of 240 patients were identified, including 62 in the PCA group and 178 in the NCA group. PCA patients had higher mean preoperative opioid consumption than NCA patients (49.2 vs 24.3 MME, P = .009). PCA patients had higher mean opioid consumption in the first 72 h in all 4 of the preoperative opioid consumption subcategories. Pain control and adverse event rates were similar between PCA and NCA in the low to high preoperative opioid consumption groups. CONCLUSION Postoperative PCA is associated with significantly more opioid consumption in the first 72 h after surgery and equal or worse postoperative pain scores compared with NCA after lumbar spinal fusion surgery.

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