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• W2077350623 abstract "THE MANAGEMENT OF postoperative pain continues to be a challenge of perianesthesia care. Opioids remain the mainstay of pharmacologic therapy. Although they are effective, their use is fraught with problems. Many patients present for surgery already receiving high-dose opioid therapy or with a history of intravenous (IV) drug abuse. In these patients, even large doses of opioids are often inadequate to control pain and, in some cases, may even worsen the problem. 1 Issues of surgical site location and the use of anticoagulation limit the use of regional techniques (ie, epidural infusions) for all patients. Evidence exists to support the claim that poor pain control is associated with a range of comorbidities including deep venous thrombosis, infection, ischemic events, pneumonia, and skin ulcers. 2 Research exists that has investigated the relationship between perioperative pain management and the development of chronic pain. This growing body of literature suggests that perioperative pain management can impact long-term outcomes with regard to the development of chronic pain states. 3-5 Moreover, opioid-induced hyperalgesia (OIH) is gaining acceptance as a contributing factor to both postoperative and chronic pain states. 1,6,7 The aim of this article is to discuss OIH in the perioperative/perianesthesia period and explain the rationale for the use of low (subanesthetic)doseketamineinfusionstoassistinmanagingthisproblem. Ketamine is auniquedrugthat interactswith manycell receptors to produce effects different from other anesthetic and analgesic agents. It isan extraordinarilypotentanalgesic agent with rapid onset. Ketamine has been used throughout its history in nearly all surgical arenas, as well as for procedural sedation in obstetrics, pediatrics, burn wards, and emergency department settings. As an anesthetic agent, ketamine is noted for its ability to produce a state of anesthesia while preserving respiratory drive and protective airway reflexes. When used as a general anesthetic, ketamine acts as a cardiovascular stimulant with bronchodilatory properties. Despite these useful properties, ketamine fell out of favor because of its association with postoperative delirium and hallucinations. For a time, it was regarded as an anesthetic most appropriateforhemodynamicshockand other frailorbrittle patients, but not well regarded for general or routine use. In addition, ketamine has become a popular drug of abuse, contributing to increased reluctance of many clinicians to administer it. However, recent data have led to a renewed interest in this unique drug for the treatment" @default.
• W2077350623 created "2016-06-24" @default.
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• W2077350623 date "2009-08-01" @default.
• W2077350623 modified "2023-09-23" @default.
• W2077350623 title "Low-Dose Ketamine Infusion for Postoperative Pain Management" @default.
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• W2077350623 doi "https://doi.org/10.1016/j.jopan.2009.05.097" @default.
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