Patients undergoing major spinal surgery continue to experience moderate-to-severe pain
during the first 2-3 days following the operative procedure. Several factors contribute to
postoperative pain in this patient population. Many patients present to surgery dependent on
relatively high doses of oral opioids; this daily administration leads to tolerance to the
effects of these drugs as well as hyperalgesia (exposure to opioids makes subsequent pain
worse). In addition, surgical procedures on the spine are very painful. Furthermore, most of
the opioids used after surgery only produce analgesia (pain relief) for 2-4 hours, which
leads to fluctuations in levels of pain control (patients have to push a button to deliver
pain medication when they begin to feel discomfort). Recent data suggest that the use of a
long-acting opioid like methadone in the operating room, which provides analgesia for 24-36
hours, may improve pain control after spinal fusion surgery. However, other pain treatment
modalities are required in this patient population. Studies have demonstrated that ketamine,
a drug that prevents pain by a mechanism different from opioids, is effective in reducing
pain medication requirements when given in the perioperative period. Small-dose infusions not
only provide analgesia, but also prevent opioid tolerance and hyperalgesia. In particular,
the combination of methadone and ketamine may be especially effective in controlling pain in
patients following major operations. The aim of this randomized clinical trial is to examine
the effect of a low-dose perioperative infusion of ketamine, when given with methadone in the
operating room, on postoperative pain medication requirements, pain scores, and clinical
recovery characteristics after spinal fusion surgery.
Phase:
Phase 4
Details
Lead Sponsor:
NorthShore University HealthSystem NorthShore University HealthSystem Research Institute