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EP161 Feasibility of postoperative ketamine infusion in general hospital wards without intense monitoring in chronic pain patients: A retrospective cohort study
  1. Tural Alekberli,
  2. Shiva Khandadashpoor,
  3. Ashok Kumar,
  4. Zeev Friedman and
  5. Naveed Siddiqui
  1. Department of Anesthesia and Pain Management, University of Toronto, Mount Sinai Hospital, Toronto, Canada


Background and Aims Chronic pain is prevalent and poses challenges in perioperative management. Opioid-dependent patients often require higher opioid doses and experience uncontrolled postoperative pain. Ketamine, a non-competitive NMDA-receptor-antagonist, has shown promise in reducing postoperative opioid-consumption and pain intensity. This study aims to evaluate ketamine-infusion safety and side-effects in postoperative wards and its impact on monitoring protocols, as well as its potential to reduce opioid-use in chronic opioid-dependent patients.

Abstract EP161 Figure 1

Side Effects for Groups

Abstract EP161 Table 1

Patient characteristics, opioid use, adverse effects, and hospital stay comparison between two groups

Methods In this retrospective chart-review we compared: patients who received intraoperative and postoperative ketamine-infusion(Ketamine-Group) and patients who did not(Control-Group). Outcomes included severity of ketamine-related adverse-effects, opioid-related side-effects measured via validated 11 item scale, and length of hospital stay.

Results This study included 202patients, ketamine-group(94-patients) and control-group(108-patients). No ketamine-related severe side-effects were observed in any group. Mild to moderate ketamine-related side-effects were reported in both groups, with mild-hallucinations being more frequent in the ketamine-group(p=0.006). Mild Nausea(P =0.052) and urinary-retention(p<0.001) was observed more frequently in ketamine-group. Constipation was observed more frequently in control-group(p=0.033). Ketamine-group had significantly higher median intraoperative opioid- use(p<0.001), and second 24-hour postoperative opioid-use(p=0.033). Median length of hospital stay in the ketamine-group was 174.55-hours compared to 116.66-hours in control-group(p<0.001)(table-1, figure-1).

Conclusions This study demonstrated the feasibility of ketamine-infusion for postoperative opioid consumption in patients with chronic pain without 1:1 monitoring in the ICU or step-down units. The use of ketamine was not associated with any major adverse effects requiring intense resource utilization. There was no direct association between ketamine-related side-effect and increased length of hospital stay. However, the long-term effects of ketamine-infusion on postoperative pain remain to be evaluated.

  • Ketamine
  • Chronic Pain
  • Pain
  • Ketamine-Infusion
  • Postoperative Pain

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