title: Prolonged perioperative infusion of low-dose ketamine does not alter opioid use after pediatric scoliosis surgery.
abstract: BACKGROUND
  Opioid consumption after posterior spinal fusion is known to be high and often exceeds those reported in other major surgical procedures. A number of clinical trials provide evidence that the perioperative use of subanesthetic doses of ketamine reduces pain and opioid requirements in some surgical procedures, but the effect of prolonged perioperative low-dose ketamine infusion in patients undergoing posterior spinal fusion for pediatric scoliosis surgery is unknown.
  
  
  OBJECTIVE
  To test the hypothesis that a 72-h perioperative low-dose ketamine infusion would decrease opioid use in pediatric patients undergoing posterior spinal fusion.
  
  
  METHODS
  In a double-blind prospective controlled trial, patients undergoing posterior spinal fusion for scoliosis were randomized to receive perioperative low-dose ketamine or placebo control. Patients received general anesthesia, intraoperative remifentanil, and morphine patient-controlled analgesia postoperatively. Daily opioid consumption, self-reported pain scores, and sedation scores were measured.
  
  
  RESULTS
  Fifty-four patients were enrolled and 50 completed the study. Contrary to our hypothesis, ketamine- and control-treated patients had similar postoperative opioid use, pain scores, and sedation scores measurements. In contrast, ketamine-treated patients required less intraoperative remifentanil compared with control (mean 2.9 mg vs. 4 mg, P = 0.0415). Number of vertebrae instrumented, time between end-of-surgery and 24 h assessment, or remifentanil doses did not impact on postoperative opioid use. Over 96-h postoperatively, morphine-equivalent consumption was lower (-0.40, P = 0.006) and sedation score was higher (0.47, P = 0.0211) in male patients, compared with female patients.
  
  
  CONCLUSIONS
  These findings do not support the use of perioperative low-dose ketamine to decrease opioid use in children with scoliosis undergoing posterior spinal fusion.
authors.affiliation: Division of Anesthesiology, Sedation and Perioperative Medicine, Children's National Health Systems, Washington, DC, USA; Division of Pain Medicine, Children's National Health Systems, Washington, DC, USA.
authors.forename: Sophie R
authors.initials: SR
authors.lastname: Pestieau
authors.forename: Julia C
authors.initials: JC
authors.lastname: Finkel
authors.forename: Mariana M
authors.initials: MM
authors.lastname: Junqueira
authors.forename: Yao
authors.initials: Y
authors.lastname: Cheng
authors.forename: John F
authors.initials: JF
authors.lastname: Lovejoy
authors.forename: Jichuan
authors.initials: J
authors.lastname: Wang
authors.forename: Zenaide
authors.initials: Z
authors.lastname: Quezado
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D004361:Drug Tolerance; D057239:Early Termination of Clinical Trials; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000517:prevention & control; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D019990:Perioperative Care; D012600:Scoliosis / Q000150:complications* / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D007649:Ketamine
keywords: children; hyperalgesia; ketamine; opioid; scoliosis; tolerance