Journal of Pain Research (Oct 2022)

Adverse Effects Associated with Patient-Controlled Analgesia with Ketamine Combined with Opioids and Ketamine Infusion with PCA Bolus in Postoperative Spine Patients: A Retrospective Review

  • Pouldar TM,
  • Maher DP,
  • Betz AW,
  • Wiegers JJ,
  • Friedman JA,
  • Zaidi SS,
  • Rejali A,
  • Tran HP,
  • Yumul R,
  • Louy C

Journal volume & issue
Vol. Volume 15
pp. 3127 – 3135

Abstract

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Tiffany M Pouldar,1 Dermot P Maher,2 Alexander W Betz,1 Jeffrey J Wiegers,1 Jeremy A Friedman,1 Sameer S Zaidi,1 Ali Rejali,3 Hai P Tran,3 Roya Yumul,1,4 Charles Louy1 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA; 2Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins Hospital, Baltimore, MD, 21205, USA; 3Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA; 4Department of Anesthesiology, David Geffen School of Medicine-UCLA, Los Angeles, CA, 90095, USACorrespondence: Charles Louy, Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd #8211, Los Angeles, CA, 90048, USA, Tel +1 310-423-5841, Email [email protected]: There has been increasing use of ketamine at subanesthetic doses as an adjunct to opioids in perioperative pain management. There are several known adverse drug effects (ADEs) associated with ketamine. However, the incidence of ADEs with ketamine infusions with patient-controlled analgesia (PCA) boluses compared with combined opioid and ketamine PCAs is not well described. The objectives of this study were to compare the incidence and type of ADEs in postoperative spine surgery patients on ketamine infusions with as-needed PCA boluses to patients on combined opioid and ketamine PCAs.Methods: The medical records of patients who underwent spine surgery between March 2016 and March 2020 who were postoperatively treated with a ketamine infusion and as-needed PCA boluses and parenteral opioids or treated with a combined opioid and ketamine PCA were reviewed. Perioperative information including patient characteristics and preoperative morphine equivalent daily dose (MEDD) were collected. Patient charts were reviewed for ADEs including psychological and neurological side effects, nausea, and new-onset tachycardia.Results: A total of 315 patients met the inclusion criteria and were included in the final analysis. Of these patients, 121 experienced at least one ADE (38%). Sixteen of the 68 ketamine infusion with PCA bolus patients (24%), 77 of the 203 hydromorphone and ketamine patients (38%), and 28 of the 44 morphine and ketamine patients (64%) experienced an ADE [p< 0.01]. In patients with preoperative MEDD ≤ 90, nausea was the only ADE that differed significantly among the three groups.Conclusion: This retrospective analysis suggests that postoperative spine patients treated with a ketamine infusion with as-needed PCA boluses and parenteral opioids were associated with fewer ADEs when compared to an intravenous combined opioid and ketamine PCA. In patients with preoperative MEDD ≤ 90, nausea with and without emesis was the only ADE that showed statistically significant difference amongst the three groups.Keywords: ketamine, opioid, patient-controlled analgesia, adverse drug effects, postoperative, retrospective

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