Intravenous sub-anesthetic ketamine for perioperative analgesia

Andrew W Gorlin, David M Rosenfeld, Harish Ramakrishna, Andrew W Gorlin, David M Rosenfeld, Harish Ramakrishna

Abstract

Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

Keywords: Ketamine; N-methyl-d-aspartate; pain.

Figures

Figure 1
Figure 1
A variety of drugs act at different anatomic locations along the pain signaling pathway. Ketamine modulates pain at the dorsal horn of the spinal cord
Figure 2
Figure 2
The activated primary nociceptive afferent from the periphery releases glutamate at the second order sensory neuron in the dorsal horn of the spinal cord which binds to N-methyl-d-aspartate receptors. Ketamine blocks the N-methyl-d-aspartate receptor which attenuates the development of central sensitization as well as opioid tolerance and hyperalgesia

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