Efficacy of Ketamine in Post Anesthesia Recovery Room

Observational Study of the Efficacy of Ketamine for Rescue Analgesia in the Post Anesthesia Recovery Room

Observational study to assess efficacy of IV ketamine bolus when used in the post anesthesia recovery unit for uncontrolled pain despite use of opioids.

Study Overview

• Status: Completed
• Conditions: Pain, Postoperative; Pain, Acute; Pain, Intractable; Ketamine Adverse Reaction; Pain, Refractory
• Intervention / Treatment: Drug: Ketamine

Detailed Description

In this observational study, the investigators will monitor all patients with significant pain after any non-cardiac surgical intervention at the University of Alberta Hospital.

After receiving an adequate dose of potent opioids (hydromorphone, morphine), the participants will receive up to 0,2-0,25 mg/kg IV ketamine bolus. In our center these boluses are given with 10-20mg increments.

The adequate dose of opioids will be determined by the attending anesthesiologist, depending on what patients received intraoperatively and on their comorbidities.

Pain scores will be assessed before and after administration of this drug. The incidence of any side effect after ketamine administration will be documented.

• Study Type: Observational
• Enrollment (Actual): 143

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, t6g2b7
      • University of Alberta Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The following patients will be identified and recruited at the post-anesthesia care unit:

Adult patients undergoing non-cardiac surgery at University of Alberta Hospital meeting the following criteria:

1. age ≥ 18
2. significant pain despite narcotics used in post anesthesia care unit
3. ketamine ordered by attending anesthesiologist

Description

Inclusion Criteria:

Adult patients undergoing non cardiac surgery at University of Alberta Hospital meeting the following criteria:

• age ≥ 18
• significant pain despite narcotics used in post-anesthesia care unit
• ketamine ordered by attending anesthesiologist

Exclusion Criteria:

• Patient refusal to receive ketamine
• Patients undergoing cardiac surgery
• Patients who received no narcotics
• Contra-indication to receiving ketamine (determined by attending anesthesiologist)

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with significative post-operative pain despite; Patients with significant pain despite receiving narcotics in PACU will receive a bolus dose of IV ketamine to assess its efficacy for pain score reduction. Bolus doses are given by 10mg IV increments, to reach approximate dose of 0,25mg/kg.	Drug: Ketamine; IV ketamine - 10mg bolus may be repeated repeated 2-3 times depending on clinical judgement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in pain score after ketamine use in PACU	The Numeric Rating Scale (NRS-11) is an 11-point scale for patient self-reporting of pain. It is what is used most often in our recovery room for pain assessment. A score of 0/10 means no pain, and 10/10 means worst pain.	in the immediate post-operative period in recovery room

Secondary Outcome Measures

Outcome Measure	Time Frame
Incidence of side effects after ketamine use	in the immediate post-operative period in recovery room

Collaborators and Investigators

• Sponsor: University of Alberta

Publications and helpful links

General Publications

• Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018 Dec 20;12(12):CD012033. doi: 10.1002/14651858.CD012033.pub4.
• Gillies A, Lindholm D, Angliss M, Orr A. The use of ketamine as rescue analgesia in the recovery room following morphine administration--a double-blind randomised controlled trial in postoperative patients. Anaesth Intensive Care. 2007 Apr;35(2):199-203.
• Weinbroum AA. A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain. Anesth Analg. 2003 Mar;96(3):789-795. doi: 10.1213/01.ANE.0000048088.17761.B4.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2020
• Primary Completion (Actual): May 28, 2021
• Study Completion (Actual): May 28, 2021

Study Registration Dates

• First Submitted: January 5, 2021
• First Submitted That Met QC Criteria: January 5, 2021
• First Posted (Actual): January 8, 2021

Study Record Updates

• Last Update Posted (Actual): September 19, 2024
• Last Update Submitted That Met QC Criteria: September 11, 2024
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Keywords: post-operative pain; pain score reduction; reduction in pain scores; ketamine use in recovery room; recovery room; ketamine recovery; ketamine rescue
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative; Pain, Intractable; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anesthetics, Dissociative; Anesthetics, Intravenous; Anesthetics, General; Anesthetics; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Ketamine
• Other Study ID Numbers: Pro00102967

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No