Adverse Effects Associated with Patient-Controlled Analgesia with Ketamine Combined with Opioids and Ketamine Infusion with PCA Bolus in Postoperative Spine Patients: A Retrospective Review

Adverse Effects Associated with Patient-Controlled Analgesia with Ketamine Combined with Opioids and Ketamine Infusion with PCA Bolus in Postoperative Spine Patients: A Retrospective Review

Objective: There has been increasing use of ketamine at subanesthetic doses as an adjunct to opioids in perioperative pain management. There are several known adverse drug effects (ADEs) associated with ketamine. However, the incidence of ADEs with ketamine infusions with patient-controlled analgesi...

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Bibliographic Details
Published in:Journal of pain research Vol. 15; pp. 3127 - 3135
Main Authors: Pouldar, Tiffany M, Maher, Dermot P, Betz, Alexander W, Wiegers, Jeffrey J, Friedman, Jeremy A, Zaidi, Sameer S, Rejali, Ali, Tran, Hai P, Yumul, Roya, Louy, Charles
Format: Journal Article
Language:English
Published: Macclesfield Dove Medical Press Limited 01-01-2022
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects:
adverse drug effects
Analgesics
Back surgery
Body mass index
Cardiac arrhythmia
Care and treatment
Chronic pain
Comparative analysis
Complications and side effects
Hallucinations
Heart rate
Hospital patients
Intensive care
Ketamine
Medical records
Morphine
Narcotics
Nausea
opioid
Original Research
Pain
patient-controlled analgesia
Patients
postoperative
retrospective
Variables
Variance analysis
California
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Summary:Objective: There has been increasing use of ketamine at subanesthetic doses as an adjunct to opioids in perioperative pain management. There are several known adverse drug effects (ADEs) associated with ketamine. However, the incidence of ADEs with ketamine infusions with patient-controlled analgesia (PCA) boluses compared with combined opioid and ketamine PCAs is not well described. The objectives of this study were to compare the incidence and type of ADEs in postoperative spine surgery patients on ketamine infusions with as-needed PCA boluses to patients on combined opioid and ketamine PCAs. Methods: The medical records of patients who underwent spine surgery between March 2016 and March 2020 who were post-operatively treated with a ketamine infusion and as-needed PA boluses and parenteral opioids or treated with a combined opioid and ketamine PCA were reviewed. Perioperative information including patient characteristics and preoperative morphine equivalent daily dose (MEDD) were collected. Patient charts were reviewed for ADEs including psychological and neurological side effects, nausea, and new-onset tachycardia. Results: A total of 315 patients met the inclusion criteria and were included in the final analysis. Of these patients, 121 experienced at least one ADE (38%). Sixteen of the 68 ketamine infusion with PCA bolus patients (24%), 77 of the 203 hydromorphone and ketamine patients (38%), and 28 of the 44 morphine and ketamine patients (64%) experienced an ADE [p<0.01]. In patients with preoperative MEDD [less than or equal to] 90, nausea was the only ADE that differed significantly among the three groups. Conclusion: This retrospective analysis suggests that postoperative spine patients treated with a ketamine infusion with as-needed PCA boluses and parenteral opioids were associated with fewer ADEs when compared to an intravenous combined opioid and ketamine PCA. In patients with preoperative MEDD [less than or equal to] 90, nausea with and without emesis was the only ADE that showed statistically significant difference amongst the three groups. Keywords: ketamine, opioid, patient-controlled analgesia, adverse drug effects, postoperative, retrospective
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ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S358770