Examining Use of Low-Dose Ketamine Infusions During the Postoperative Period: A Retrospective Study Comparing Opioid-Tolerant and Nonopioid-Tolerant Patients.
Erin E Martin, Michelle A Ochs Kinney, Michael J Cianci and 2 others
PMID 33501905WHAT IT FOUND
Opioid tolerance did not affect ketamine side-effect risk or dose needs.
Hallucination-like effects occurred in 15.4% of patients, and older age raised risk.
Key findings
01Psychotomimetic adverse effects potentially related to ketamine occurred in 92 patients (15.4%), and the percentage was similar for opioid-tolerant and non-opioid-tolerant patients.
02Opioid tolerance, maximum ketamine dose, and the dose used for the longest duration were not associated with psychotomimetic adverse effects.
03Older age was associated with increased odds of a psychotomimetic adverse effect (odds ratio 1.29 for every 10-year increase).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective chart review, not a planned trial, so missing or fragmented records reduced the analyzed sample from 1,123 identified patients to 596. Adverse effects were identified from existing documentation in electronic health records, not from a planned prospective assessment. All patients came from one institution that used a standardized ketamine order set with limited dose choices, so results may not apply to other settings or dosing practices. No formal power analysis was performed, and the study was not designed to determine optimal ketamine dosing or analgesic efficacy.
Declared interests
The authors reported no financial relationships or outside interests to disclose.
The easy way to misread this
Do not use this study to choose a ketamine dose for postoperative pain relief. It did not show a relationship between ketamine dose and analgesic efficacy, and it was a retrospective chart review rather than a trial testing dosing.