Kingsuk Ganguly CA-2

Analog of PCP- phencyclidine

Psychogenic hallucinogenic

NMDA antagonist Works throughout the CNS

Inhibits excitatory neurotransmitter effects

Stimulates sympathetic nervous systemHR and BP

dissociates the thalamus (relay center) from the limbic cortex (awareness of sensation) can be given IV and IM Increase in BP and HR BRONCHODILATOR with little effect on resp drive

NMDA antagonist- BLOCKS pain transmission impulses in the spinal cord Works on various other receptors causing analgesia

Significantly reduces opioid consumption

PACU 48 hr postoperative period

6 weeks post-op

Decreases central excitability Modulates opiate receptors

165 patients with chronic back pain were enrolled in a study for elective lumbar surgery.
Required 30% less morphine 24 hr post-op period
Reported 27% reduction in pain intensity in PACU Was not associated with significant change in HR

or BP in PACU

Meta-analysis involving 4,701 patients

Greatest benefit in thoracic, upper abdominal,

and major orthopedic surgeries Despite less opioid, 78% of treatment groups experienced less pain Delay in time of first analgesic dose in PACU Less total opioid requirements

Less PACU time Better rehabilitation Lower chance of progression to chronic pain

Has shown minimal benefit in smaller surgeries and in those causing mild pain Side effects of hallucinations and nightmares

In patients with chronic pain, ketamine infusions have shown benefit as well These patients need to be on a monitored bed; due to Ketamines cardiovascular effects
Due to increase work on the heart, use with

caution in patients with CAD, uncontrolled HTN, aneurysms, CHF

Neuropsychiatric effects
Hallucinations Nightmares Nystagmus

Cardiac arrhythmias HTN Sedation Nausea Dizziness Blurry Vision

Can be decreased by using benzos or haldol

Less PONV Less pruritis Less constipation Less urinary retention Less Respiratory Depression and apnea

Elia N, Tramr. Pain. 2005 Jan;113(1-2):61-70. Ketamine and postoperative pain--a quantitative systematic review of randomised trials. Laskowski, K. Stirling A. Can J Anes. 2011. 58:911-923 Morgan, E. Mikhail, M. Murray, M. Clinical Anesthesiology. Lange. 4th edition. Wall PD: The prevention of postoperative pain. Pain 1988;33:289 90