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Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions
  1. Eric S. Schwenk, MD*,
  2. Stephen F. Goldberg, MD*,
  3. Ronak D. Patel, MD*,
  4. Jon Zhou, MD,
  5. Douglas R. Adams, BS*,
  6. Jaime L. Baratta, MD*,
  7. Eugene R. Viscusi, MD* and
  8. Richard H. Epstein, MD
  1. From the *Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; †Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA; and ‡Department of Anesthesiology, University of Miami, Miami, FL
  1. Address correspondence to: Eric S. Schwenk, MD, Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Suite 8130, Gibbon Bldg, 111 S 11th St, Philadelphia, PA 19107 (e-mail: Eric.Schwenk{at}


Abstract High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions and which ADEs most frequently led to discontinuation. Spine surgery was chosen because of its association with moderate to severe pain and a relatively high use of ketamine infusions in this population at our hospital.

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  • Eric S. Schwenk, Stephen F. Goldberg, Ronak D. Patel, Jon Zhou, Douglas R. Adams, Jaime L. Baratta, and Richard H. Epstein have no conflicts of interest to declare. Eugene R. Viscusi has served as a consultant for AcelRx, Medicines Company, Mallinkrodt, Trevena, Cara Pharmaceuticals, and Astra Zeneca. He has received grant money in the past from AcelRx and Pacira. He has been a paid lecturer for AcelRx, Merck, Salix, and Mallinkrodt.

    Portions of this manuscript were presented at the 2013 Annual Meeting of the American Society of Anesthesiologists and at the 2014 Spring Meeting of the American Society of Regional Anesthesia and Pain Medicine.