A Randomized Controlled Trial of Intraoperative Ketamine for Acute Postsurgical Pain after Breast Cancer Surgery: The Moderating Effect of Baseline Temporal Summation of Pain
Abstract
Background: Activation of nociceptive pathways by surgical trauma can induce central sensitization, which is associated with greater pain severity and persistence. The N -methyl- d -aspartate receptor antagonist ketamine blocks central sensitization but has a variable track record for preventing postsurgical pain. Patient-level factors contribute to variability in pain and may serve as markers of differential efficacy of preventive effect.
Methods: This prospective, longitudinal randomized controlled trial investigated the effectiveness of intraoperatively administered ketamine to decrease postoperative pain after breast surgery. Before surgery, patients reported demographic and medical information and completed validated pain and psychosocial questionnaires. A subset of patients also underwent quantitative sensory testing to assess baseline temporal summation of pain (central sensitization tendency). Analyses of covariance, controlling for relevant pre- and perioperative factors, examined treatment group (ketamine vs . saline) differences in 2-week postoperative pain outcomes. Exploratory moderation analysis explored whether the efficacy of ketamine differed based on patients' baseline temporal summation of pain.
Results: Of the sample of 225 patients, 113 received ketamine, and 112 received placebo. The majority of patients underwent lumpectomy (53%), with 16% undergoing mastectomy and 30% mastectomy with reconstruction. There were no significant treatment group…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 225 participants or records.
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