Get access

Perioperative ketamine does not prevent chronic pain after thoracotomy

Authors

  • Christian Dualé,

    Corresponding author
    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    2. CHU Clermont-Ferrand (Inserm CIC 501), Centre de Pharmacologie Clinique, Rue Montalembert, BP 69, F-63003 Clermont-Ferrand, France
    3. Inserm, CIC 501, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Fabrice Sibaud,

    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Virginie Guastella,

    1. CHU Clermont-Ferrand, Centre de Soins Palliatifs, Hôpital Nord, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Laurent Vallet,

    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Yves-Alain Gimbert,

    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Hammou Taheri,

    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    Search for more papers by this author
  • Marc Filaire,

    1. CHU Clermont-Ferrand, Chirurgie Générale et Thoracique, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    2. University Clermont1, F-63001 Clermont-Ferrand, France
    Search for more papers by this author
  • Pierre Schoeffler,

    1. CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
    2. University Clermont1, F-63001 Clermont-Ferrand, France
    Search for more papers by this author
  • Claude Dubray

    1. CHU Clermont-Ferrand (Inserm CIC 501), Centre de Pharmacologie Clinique, Rue Montalembert, BP 69, F-63003 Clermont-Ferrand, France
    2. Inserm, CIC 501, F-63003 Clermont-Ferrand, France
    3. University Clermont1, F-63001 Clermont-Ferrand, France
    Search for more papers by this author

CHU Clermont-Ferrand (Inserm CIC 501), Centre de Pharmacologie Clinique, Rue Montalembert, BP 69, F-63003 Clermont-Ferrand, France. Tel.: +33 473178418; fax: +33 473178412. cduale@chu-clermontferrand.fr

ABSTRACT

Thoracotomy is often responsible for chronic pain, possibly of neuropathic origin. To confirm preclinical studies, the preventive effects of perioperative ketamine were tested in a randomized, double-blind, placebo-controlled clinical trial on persistent neuropathic pain after thoracotomy. Eighty-six patients scheduled for thoracotomy under standardised general anaesthesia were randomised to receive either ketamine (1mgkg−1 at the induction, 1mgkg−1h−1 during surgery, then 1mgkg−1 during 24h; n=42) or normal saline (n=44). Postoperative analgesia included a single dose of intrapleural ropivacaine, intravenous paracetamol and nefopam, and patient-controlled intravenous morphine. Vital parameters and analgesia were recorded during the 48 first postoperative hours. Seventy-three patients were followed up. The patient's chest was examined 1–2 weeks, 6 weeks and 4 months after surgery. At the last two observations, spontaneous pain score over a one-week period (visual analogue scale), neuropathic pain score (NPSI), and intake of analgesics, were assessed. No drug affecting neuropathic pain (except opiates) was given during the follow-up. Two patients in each group were lost to follow-up after the 6 week visit. Ketamine improved immediate postoperative pain, but the groups were similar in terms of neuropathic pain and intake of analgesics, 6 weeks (NPSI score: ketamine: 1.25 [0–4.125]; placebo: 1 [0–4]) and 4 months after surgery. Thus, ketamine given in 24-h infusion failed to prevent chronic neuropathic pain after thoracotomy. Other perioperative preventive long-lasting treatments or techniques could be tested in this context.

Ancillary