Journal of Pain Research (Mar 2023)

Single-Dose of Postoperative Ketamine for Postoperative Pain After Mastectomy: A Pilot Randomized Controlled Trial

  • Doan LV,
  • Li A,
  • Brake L,
  • Ok D,
  • Jee HJ,
  • Park H,
  • Cuevas R,
  • Calvino S,
  • Guth A,
  • Schnabel F,
  • Hiotis K,
  • Axelrod D,
  • Wang J

Journal volume & issue
Vol. Volume 16
pp. 881 – 892

Abstract

Read online

Lisa V Doan,1 Anna Li,1 Lee Brake,1 Deborah Ok,1 Hyun Jung Jee,1 Hyung Park,2 Randy Cuevas,1 Steven Calvino,1 Amber Guth,3 Freya Schnabel,3 Karen Hiotis,3 Deborah Axelrod,3 Jing Wang1,4 1Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA; 2Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; 3Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; 4Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY, USACorrespondence: Lisa V Doan, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, 240 E 38th St, 14th Floor, New York, NY, 10016, USA, Tel +1 212201-1004, Email [email protected] and Objectives: Perioperative ketamine has been shown to reduce opioid consumption and pain after surgery. Ketamine is most often given as an infusion, but an alternative is single-dose ketamine. Single-dose ketamine at up to 1 mg/kg has been shown to reduce symptoms of depression, and a wide range of dosages has been used for pain in the emergency department. However, limited data exists on the tolerability and efficacy of a single-dose of ketamine at 0.6 mg/kg for pain when administered immediately after surgery. We conducted a pilot study of single-dose ketamine in patients undergoing mastectomy with reconstruction, hypothesizing that a single-dose of ketamine is well tolerated and can relieve postoperative pain and improve mood and recovery.Methods: This is a randomized, single-blind, placebo-controlled, two-arm parallel, single-center study. Thirty adult women undergoing mastectomy with reconstruction for oncologic indication received a single-dose of ketamine (0.6mg/kg) or placebo after surgery in the post-anesthesia care unit (PACU). Patients were followed through postoperative day (POD) 7. The primary outcome was postoperative pain measured by the Brief Pain Inventory (BPI) pain subscale on POD 1 and 2. Secondary outcomes include effects on opioid use, PROMIS fatigue and sleep, mood, Quality of Recovery-15, and the Breast Cancer Pain Questionnaire.Results: Side effects were minor and not significantly different in frequency between groups. The ketamine group reported lower scores on the BPI pain severity subscale, especially at POD 7; however, the difference was not statistically significant. There were no statistically significant differences between ketamine and placebo groups for the secondary outcomes.Conclusion: A single-dose of ketamine at 0.6mg/kg administered postoperatively in the PACU is well tolerated in women undergoing mastectomy and may confer better pain control up to one week after surgery. Future studies with larger sample sizes are necessary to adequately characterize the effect of postoperative single-dose ketamine on pain control in this population.Keywords: postoperative pain, non-opioid, analgesia

Keywords