Small-dose S(+)-ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty

• Published in: Anesthesia and analgesia Vol. 92; no. 5; pp. 1290 - 1295
• Main Authors: HIMMELSEHER, Sabine, ZIEGLER-PITHAMITSIS, Doris, ARGIRIADOU, Helena, MARTIN, Jan, JELEN-ESSELBORN, Sabine, KOCHS, Eberhard
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.05.2001
• Subjects: Aged; Amides - administration & dosage; Amides - adverse effects; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics - administration & dosage; Analgesics - adverse effects; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Epidural; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Arthroplasty, Replacement, Knee; Biological and medical sciences; Double-Blind Method; Female; Humans; Ketamine - administration & dosage; Ketamine - adverse effects; Male; Medical sciences; Middle Aged; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Pain Measurement; Pain, Postoperative - prevention & control; Patient Satisfaction; Prospective Studies; Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors; Ropivacaine; Knee; Human; Postoperative; Enantiomer(+); Prosthesis; Low dose; Glutamate receptor; Ropivacaine; Knee disease; Local anesthetic; Prevention; Analgesia; Chemotherapy; Analgesic; Regional anesthesia; Orthopedic surgery; Pain; Ketamine; Extradural administration; Organic amide; Antagonist; NMDA receptor
• DOI: 10.1097/00000539-200105000-00040
• ISSN: 0003-2999

Reduction of nociceptive input through blockade of N-methyl-D-aspartate (NMDA) receptors has been reported. We compared the effects of epidural S(+)-ketamine versus placebo on postoperative pain in a randomized, double-blinded study in 37 patients undergoing unilateral knee arthroplasty. After lumbar epidural anesthesia with ropivacaine (10 mg/mL, 10-20 mL), 19 patients received 0.9% epidural saline, and 18 patients received 0.25 mg/kg epidural S(+)-ketamine 10 min before surgical incision. After surgery, patient-controlled epidural analgesia with ropivacaine was provided. During the first 8 h after surgery, visual analog scale pain rating was similar between groups. Twenty-four and 48 h after surgery, patients anesthetized with ropivacaine had higher visual analog scale ratings at rest and during movement (P < 0.05) than patients anesthetized with S(+)-ketamine and ropivacaine. Forty-eight hours after surgery, patients anesthetized with ropivacaine also consumed more ropivacaine (558 +/- 210 mg) (P < 0.01) than those anesthetized with S(+)-ketamine and ropivacaine (319 +/- 204 mg). Adverse events were similar between groups. Patients who received S(+)-ketamine and ropivacaine rated the quality of their pain therapy better than those who received ropivacaine alone (P < 0.05). We conclude that the combination of S(+)-ketamine and ropivacaine in epidural anesthesia increases postoperative pain relief when compared with ropivacaine. Epidural S(+)-ketamine applied with ropivacaine before surgery is a rational approach to decrease injury-induced pain sensitization. Epidural blockade with an N-methyl-D-aspartate receptor antagonist and a local anesthetic may provide better analgesia in the postoperative period than a local anesthetic alone.