S-Ketamine Reduces the Risk of Rebound Pain in Patients Following Total Knee Arthroplasty: A Randomized Controlled Trial.
Summary
In a double-blind RCT of 356 TKA patients, intraoperative S-ketamine infusion reduced 12-hour rebound pain incidence (21.3% vs 34.8%; adjusted RR 0.62), delayed RP onset, lowered early pain, reduced opioid use, and improved recovery quality and satisfaction without new safety signals.
Key Findings
- S-ketamine reduced 12-hour postoperative rebound pain incidence (21.3% vs 34.8%; adjusted RR 0.62).
- Delayed onset of rebound pain and prolonged time to first rescue analgesia.
- Improved early pain scores, decreased opioid consumption, and higher patient satisfaction within 3 days.
Clinical Implications
Consider intraoperative S-ketamine infusion as part of multimodal analgesia for TKA to reduce rebound pain and improve early recovery, with monitoring for psychotomimetic effects per institutional protocols.
Why It Matters
Provides level I evidence for a simple intraoperative intervention to mitigate clinically problematic rebound pain after TKA, with immediate applicability to anesthetic practice.
Limitations
- Short follow-up (3 days) limits assessment of later outcomes and functional recovery.
- Single dosing regimen and surgical context (TKA) may limit generalizability to other procedures.
Future Directions
Evaluate optimal dosing/timing, extend follow-up for functional outcomes and chronic pain, and test in other surgeries and high-risk populations.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized, double-blind, placebo-controlled trial providing highest level clinical evidence.
- Study Design
- OTHER