S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial

Background Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown. Methods We randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml-1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery. Results Of the 100 patients analyzed, patients receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml-1 (74.7 mg) or 0.25 mg ml-1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: -20.6 mg; 95% confidence interval [CI]: -41 to -0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups. Conclusions Oxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

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S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: a randomized, double-blind, placebo-controlled clinical trial

10.1101/2021.01.22.21250352 ◽

2021 ◽

Author(s):

Elina C.V. Brinck ◽

Taru Virtanen ◽

Sanna Mäkelä ◽

Venla Soini ◽

Ville-Veikko Hynninen ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Fusion ◽

Opioid Consumption ◽

Controlled Clinical Trial ◽

Dependent Manner ◽

Lumbar Spinal Fusion ◽

Patient Controlled Analgesia ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

AbstractBACKGROUNDSpinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.METHODSWe randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml−1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.RESULTSOf the 100 patients analyzed, patients receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml−1 (74.7 mg) or 0.25 mg ml−1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: −20.6 mg; 95% confidence interval [CI]: −41 to −0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups.CONCLUSIONSOxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

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

Neurosurgery ◽

10.1093/neuros/nyaa120 ◽

2020 ◽

Vol 87 (3) ◽

pp. E311-E312

Author(s):

Nathaniel W Jenkins ◽

James M Parrish ◽

Kern Singh

Keyword(s):

Adverse Events ◽

Spinal Fusion ◽

Opioid Consumption ◽

Lumbar Spinal Fusion ◽

Patient Controlled Analgesia ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

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Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

PeerJ ◽

10.7717/peerj.7967 ◽

2019 ◽

Vol 7 ◽

pp. e7967 ◽

Cited By ~ 1

Author(s):

Ke Chen ◽

Lizhen Wang ◽

Meng Ning ◽

Lianjie Dou ◽

Wei Li ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Fusion ◽

Control Group ◽

Controlled Clinical Trial ◽

Single Shot ◽

Lumbar Spinal Fusion ◽

Ultrasound Guided ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

Objective Ultrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery. Methods A prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively. Results Opioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups. Conclusion Our study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

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

Neurosurgery ◽

10.1093/neuros/nyaa111_s013 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S13-S13

Author(s):

Arpan A Patel ◽

Corey T Walker ◽

Virginia Prendergast ◽

John J Radosevich ◽

Doneen Grimm ◽

...

Keyword(s):

Adverse Events ◽

Spinal Fusion ◽

Opioid Consumption ◽

Lumbar Spinal Fusion ◽

Patient Controlled Analgesia ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

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

Neurosurgery ◽

10.1093/neuros/nyaa111 ◽

2020 ◽

Vol 87 (3) ◽

pp. 592-601 ◽

Cited By ~ 1

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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