S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.

<h4>Background</h4>Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine...

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Autores principales:	Elina C V Brinck, Taru Virtanen, Sanna Mäkelä, Venla Soini, Ville-Veikko Hynninen, Jukka Mulo, Urmas Savolainen, Juho Rantakokko, Kreu Maisniemi, Antti Liukas, Klaus T Olkkola, Vesa Kontinen, Pekka Tarkkila, Marko Peltoniemi, Teijo I Saari
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/699d72d9c42a4f33971aa6c455afc4b9
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spelling	oai:doaj.org-article:699d72d9c42a4f33971aa6c455afc4b92021-12-02T20:11:00ZS-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.1932-620310.1371/journal.pone.0252626https://doaj.org/article/699d72d9c42a4f33971aa6c455afc4b92021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252626https://doaj.org/toc/1932-6203<h4>Background</h4>Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.<h4>Methods</h4>We randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml-1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.<h4>Results</h4>Of the 100 patients analyzed, patients receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml-1 (74.7 mg) or 0.25 mg ml-1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: -20.6 mg; 95% confidence interval [CI]: -41 to -0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013-0.32, P = 0.033). The occurrence of adverse events was similar among the groups.<h4>Conclusions</h4>Oxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.Elina C V BrinckTaru VirtanenSanna MäkeläVenla SoiniVille-Veikko HynninenJukka MuloUrmas SavolainenJuho RantakokkoKreu MaisniemiAntti LiukasKlaus T OlkkolaVesa KontinenPekka TarkkilaMarko PeltoniemiTeijo I SaariPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252626 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Elina C V Brinck Taru Virtanen Sanna Mäkelä Venla Soini Ville-Veikko Hynninen Jukka Mulo Urmas Savolainen Juho Rantakokko Kreu Maisniemi Antti Liukas Klaus T Olkkola Vesa Kontinen Pekka Tarkkila Marko Peltoniemi Teijo I Saari S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
description	<h4>Background</h4>Spinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.<h4>Methods</h4>We randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml-1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.<h4>Results</h4>Of the 100 patients analyzed, patients receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml-1 (74.7 mg) or 0.25 mg ml-1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: -20.6 mg; 95% confidence interval [CI]: -41 to -0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml-1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013-0.32, P = 0.033). The occurrence of adverse events was similar among the groups.<h4>Conclusions</h4>Oxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.
format	article
author	Elina C V Brinck Taru Virtanen Sanna Mäkelä Venla Soini Ville-Veikko Hynninen Jukka Mulo Urmas Savolainen Juho Rantakokko Kreu Maisniemi Antti Liukas Klaus T Olkkola Vesa Kontinen Pekka Tarkkila Marko Peltoniemi Teijo I Saari
author_facet	Elina C V Brinck Taru Virtanen Sanna Mäkelä Venla Soini Ville-Veikko Hynninen Jukka Mulo Urmas Savolainen Juho Rantakokko Kreu Maisniemi Antti Liukas Klaus T Olkkola Vesa Kontinen Pekka Tarkkila Marko Peltoniemi Teijo I Saari
author_sort	Elina C V Brinck
title	S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
title_short	S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
title_full	S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
title_fullStr	S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
title_full_unstemmed	S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.
title_sort	s-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: a randomized, double-blind, placebo-controlled clinical trial.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/699d72d9c42a4f33971aa6c455afc4b9
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S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: A randomized, double-blind, placebo-controlled clinical trial.

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