Perioperative ketamine to reduce and prevent acute and chronic post-thoracotomy pain: a randomized, double-blind, placebo-controlled clinical trial.

Summary

In a double-blind RCT of 200 thoracotomy patients, pre-emptive ketamine reduced the incidence of chronic post-thoracotomy pain—particularly neuropathic features—without reducing in-hospital opioid consumption or NRS scores beyond the immediate 6-hour period. The study supports ketamine’s role in preventing chronic postsurgical neuropathic pain after thoracotomy.

Key Findings

• Pre-emptive ketamine reduced coughing-related pain in the first 6 postoperative hours versus placebo.
• No difference in NRS pain scores at rest or with coughing on PODs 1–8 and no reduction in opioid consumption.
• Significantly lower incidence of chronic postoperative pain with neuropathic features (S-LANSS ≥12 at 30 days) in the ketamine group.

Clinical Implications

Consider incorporating pre-emptive ketamine into thoracotomy analgesic pathways to reduce chronic neuropathic pain risk, with the understanding that acute opioid requirements may not decrease.

Limitations

• Single trial with limited detail on dosing regimen in the abstract; external generalizability needs confirmation.
• Telephone survey for S-LANSS at follow-up may introduce reporting bias; acute pain endpoints showed no sustained benefit.

Future Directions

Define optimal ketamine dosing/timing, explore patient subgroups most likely to benefit, and assess longer-term outcomes beyond 90 days and multimodal combinations.