Intraoperative Ketamine Administration for Enhanced Pain Management

Introduction: Ketamine has been around for over 50 years in the United States and is now commonly used in anesthesia practice. When administered in subanesthetic doses, it is an effective alternative to opioid administration for postoperative pain control without the unwanted side effects of higher doses. Total joint arthroplasty is one of the most performed orthopedic surgeries and effective pain control is a must. The research evidence reflected lower pain scores in the immediate and early postoperative periods (6-24 hours) in patients who underwent total joint replacement surgeries and received intraoperative ketamine. Methods: The project design was a retrospective chart review using Cerner 1Chart of patients aged 40 to 65 years old who underwent total knee arthroplasty or total hip arthroplasty surgery. The postoperative pain scores of the patients who did and did not receive intraoperative ketamine were collected and analyzed pre and post educational intervention. Results: A total of 80 cases were analyzed with half being pre-educational intervention and 40 pos-educational intervention. A Chi-Square Test and t-test were performed on the data obtained from the retrospective chart review. There were no statistically significant differences in ketamine administration by CRNAs before and after the intervention (chi-square = .29, p = .59). There were no statistically significant differences in patient’s self-reported levels of pain based on the administration of ketamine (t(78) = 1.13, p = .26). Discussion: The overall sample size was relatively small, and more data could be collected over a longer time frame to be analyzed. Assessing and trending the postoperative pain scores over a 6–24-hour period could yield useful information.