The role of perioperative ketamine in postoperative pain control following spinal surgery

Abstract

Opioid abuse has rapidly developed into an epidemic across the United States. Patients are often introduced to opioids following surgical procedures-this is particularly relevant following spinal surgery. Surgeons can help reduce this opioid burden by finding alternatives to narcotic analgesia in the postoperative period. One such medication that has shown potential in this role is ketamine, which has been studied in various surgical specialties. A review was performed of current literature regarding ketamine use in the perioperative period specific to spinal surgery. This review focused on prospective randomized control trials; the primary endpoint was opioid consumption in the postoperative period, monitored through patient-controlled analgesia (PCA) use. Both pediatric and adult spinal surgery patients were included; cervical, thoracic, and lumbar procedures were also all included. 10 studies were selected for this reviewed based on inclusion criteria, published between 2004 and 2017. 7 of these studies demonstrated a significant decrease in postoperative opioid use with the integration of ketamine in the perioperative period, while 3 trials showed no significant difference in opioid consumption. There is inherent difficulty in standardizing studies of this nature-dosing protocols, medication timing, and supplemental analgesia were variable throughout the included studies. However, this review of the most up-to-date prospective studies indicate ketamine has potential to play a significant role in reducing opioid requirements following spinal surgery, and further study is warranted in this field.

Keywords: Ketamine; opioid; pain control; spinal surgery.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jss-19-306). LGL reports personal fees from Medtronic, grants and personal fees from DePuy-Synthes Spine, personal fees from K2M, non-financial support from Broadwater, non-financial support from Seattle Science Foundation, grants and non-financial support from Scoliosis Research Society, non-financial support from Stryker Spine, non-financial support from The Spinal Research Foundation, grants from EOS, grants from Setting Scoliosis Straight Foundation, personal fees from Fox Rothschild, LLC, personal fees from Quality Medical Publishing, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, outside the submitted work; Dr. Lehman reports personal fees from Medtronic, personal fees from Stryke Synthes Spine, grants from Department of Defense grant for research support, outside the submitted work. LGL serves as an unpaid editorial board member of Journal of Spine Surgery from Oct 2019 to Oct 2021. The other authors have no conflicts of interest to declare.

2020 Journal of Spine Surgery. All rights reserved.