Back to 2024 Abstracts
Ketamine Reduces Opiate Use and Pain Scores in Patients Receiving Low Dose Naloxone for Spinal Cord Protection During Thoracoabdominal Aortic Aneurysm Repair
Eric Johnson, Dan Davenport, Joseph Bobadilla, Eric Endean, David Minion, Ryan King, Sam Tyagi
University of Kentucky, Lexington, KY
BACKGROUND: Thoracoabdominal Aortic Aneurysm (TAAA) is a life-threatening condition that necessitates repair to prevent fatal outcomes. A significant risk associated with both endovascular and open repairs is spinal cord ischemia (SCI), which can lead to paresis and paraplegia. The incidence of SCI has been reported to be as high as 10.6% in endovascular repairs and 35% in open repairs. To mitigate this risk, spinal cord protection bundles have been developed and implemented, successfully reducing the risk of SCI to 4%. Low-dose naloxone, a component of the SCI protection bundle, has been shown in our previous work to have the unintended consequence of worsening perioperative pain scores and increasing the need for postoperative opiate administration. This indicates a critical gap in the current pain management strategy within the SCI protection protocol, necessitating an alternative approach to reduce postoperative pain and opiate use effectively. Our study aimed to identify a pain management strategy that alleviated perioperative pain and reduced the reliance on opiates.
METHODS:We conducted an IRB approved, randomized, double-blind, placebo-controlled trial to investigate the effects of adding ketamine on postoperative pain and opiate administration in TAAA patients undergoing the SCI protection bundle. The primary outcome of interest was the total fentanyl administered per 6-hour interval (mcg) for the first 48 hours after the operation. Secondary outcomes include the average pain score (0-10) over 6-hour intervals up to 72 hours, and the total acetaminophen administered per 24-hour interval (mg) up to 48 hours. Overall mean outcomes were compared between the Ketamine and placebo group using a repeated measures general linear mixed model with an autoregressive covariance structure. IBM SPSS Statistics (Version 29, Armonk, NY) was used for all analyses. P < .05 was set as the threshold for statistical significance.
RESULTS: Twenty patients, ten in each group, were enrolled in the study with mean age 66.1 (SD 8.8), mean BMI 28.2 (SD 8.7), and 10 males (50.0%). The estimated mean 6-hour Fentanyl use over the first 48 hours for Ketamine patients was 49.0 mcg (95% CI 28.7 - 69.3) vs. 110.0 (95% CI 89.8 - 130.3) for placebo, (p = .019) [
Figure]. The estimated mean 24-hour acetaminophen use over the first 48 hours for Ketamine patients was 552.5 mg (95% CI 257.3 - 847.7) vs. 1,527.5 (95% CI 884.7 - 2,170.3) for placebo, (p = .008). The estimated 6-hour mean pain score for Ketamine patients was 1.9 (95% CI .4 - 3.4) vs. 4.2 (95% CI 2.6 - 5.8) for placebo, (p = .040).
CONCLUSIONS: The results of our study show that adding ketamine administration to a TAAA SCI-protection bundle reduces the post-operative quantity of opiates administered and reduces patient reported pain scores. Thus, Ketamine has the potential to reduce surgery-induced opioid dependence.
Back to 2024 Abstracts
