Ketamine is an anesthetic that can prevent persistent post-surgical pain in patients who have undergone major surgery. That's a welcome alternative, given the significant opiate addiction crisis plaguing our nation.
Opioid addiction is a crisis in this country and any opportunity to curb the use of these drugs is thoroughly welcome. As of 2014, 21.5 million Americans 12 or older were said to suffer from a substance-use disorder. Of those, 1.9 million involved prescription painkillers and 586,000 had a use disorder involving heroin.
For one of every eight major surgeries, patients suffer from what is referred to as persistent post-surgical pain (PPSP), defined as pain that is still present three to six months after the surgical procedure, where the pain was rated three or higher on a 10-point pain scale.
Researchers from Austin Hospital and University of Melbourne, Department of Anesthesia, performed a meta-analysis comparing the use of ketamine (which is also abused as a party drug) with other analgesics such as lidocaine, NMDA-receptor antagonists and gabapentin. What they found was that ketamine was the only one with evidence of being able to prevent PPSP.
Based on the results of the meta-analysis, Philip Peyton, MD and colleagues conducted a pilot study of 80 patients, which they included in an updated meta-analysis. And they found that patients were half as likely to suffer PPSP with ketamine versus placebo.
“A large multicenter randomized trial of the effectiveness of perioperative intravenous ketamine is warranted. Demonstration of clinical effectiveness would promote widespread change in clinical anesthesia practice,” stated Dr. Peyton. “Developed countries spend billions of dollars on treatment of persistent post-surgical pain. Should further studies confirm our findings on ketamine, healthcare systems will have a cheap and effective means to treat this condition, allowing huge cost savings.”
We have written on ketamine before. It is increasingly being investigated for its potential use in treating refractory depression (one that does not respond to antidepressants), pain management, and neuropathic pain.
Many cases of addiction to opiates arises from over-prescription of pain killers. If we can focus on preventing pain and preventing opiate use, we can avert many potential addictions.