title: A randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery.
abstract: OBJECTIVE
  We hypothesized that patients who received ketamine during thoracic surgery would benefit from suppression of the inflammatory cascade, represented by lower interleukin (IL)-6 and C-reactive protein (CRP) plasma levels.
  
  
  METHODS
  This study was a randomized, double blind, placebo controlled clinical trial of ketamine in patients undergoing thoracic surgery. The setting was a single university teaching hospital. Forty patients who presented to the preoperative clinic prior to thoracic surgery (20 control, 20 treatment) were randomized to receive either a 0.5 mg/kg ketamine bolus or an equivalent volume of normal saline intravenously prior to chest wall incision. Plasma samples taken prior to induction of anesthesia and at 24 h following surgery were assayed for IL-6 and CRP levels. Verbal pain scores were reported at 4 and 24 h following surgery and at discharge.
  
  
  RESULTS
  IL-6 plasma levels did not differ significantly at 24 h for patients receiving ketamine (245 ± 287 pg/ml, mean ± SD) compared to patients who received placebo (269 ± 210 pg/ml), p = 0.39. Additionally, CRP levels at 24 h were not significantly different (8.8 ± 4.5 mg/dl for ketamine, 9.3 ± 5.6 mg/dl for placebo patients), p = 0.37. Finally, verbal pain scores were not significantly different between patient groups at 4 or 24 h, or at discharge.
  
  
  CONCLUSIONS
  These findings suggest that the routine use of a single dose of ketamine prior to chest wall incision is not effective at reducing pain or inflammation in thoracic surgery patients at 24 h postoperatively.
authors.affiliation: Department of Anesthesiology, Pitt Count Memorial Hospital, Greenville, NC 27858, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: D'Alonzo
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Mihai
authors.initials: M
authors.lastname: Podgoreanu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
mesh_terms: D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D010919:Placebos; D011300:Preoperative Care / Q000379:methods; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D000700:Analgesics; D015850:Interleukin-6; D010919:Placebos; D007649:Ketamine; D002097:C-Reactive Protein