Perioperative Ketamine Infusion
CA-2 · I.A.4.c.6 II.D.3.f.4 II.D.1.b.1.e
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The ASRA/AAPM/ASA consensus guideline supports ketamine for acute pain as a stand-alone treatment and as an adjunct to opioids, with contraindications similar to those for chronic pain.
PMID 29870457
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Across 130 trials and 8,341 patients, perioperative ketamine cut 24-hour opioid consumption by about 8 mg morphine equivalents — roughly 19% — with bolus doses mostly 0.25 to 1 mg and infusions 2 to 5 micrograms per kilogram per minute.
PMID 30570761
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In the PODCAST trial a single subanaesthetic dose of ketamine did not reduce delirium in older adults after major surgery (19.5% versus 19.8%) and increased hallucinations and nightmares with rising dose.
PMID 28576285
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Ketamine's relationship with delirium is U-shaped: cumulative doses at or below 0.35 mg/kg were associated with less delirium, higher doses with none, and the minimum risk fell at 0.25 to 0.34 mg/kg.
PMID 40619168
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In patients already taking opioids, ketamine reduced cumulative opioid consumption by roughly 97 mg at 24 hours and lowered sedation, while the effect on pain intensity itself was small and low-certainty.
PMID 35065394
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In opioid-dependent patients having lumbar fusion, intraoperative S-ketamine reduced 24-hour morphine consumption from 121 mg to 79 mg and reduced sedation, without more hallucinations or nightmares.
PMID 28067693
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