Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery

The aim of this study was to determine if preemptive administration of systemic ketamine decreases postoperative pain when compared with postwound closure administration of ketamine. Patients undergoing abdominal procedures were randomized into a preemptive or postwound closure ketamine administration group. Before surgical incision, patients in the preemptive group (n = 20) were given 0.5 mg/kg ketamine followed by a ketamine infusion of 10 mu g.kg(-1).min(-1), which was discontinued at abdominal closure. The patients in the postwound closure (n = 20) group were given 0.5 mg/kg of ketamine immediately after abdominal closure. Postoperatively, all patients received intravenous (IV) morphine in the postanesthesia care unit (PACU) and were started on IV morphine patient-controlled analgesia after discharge from the PACU. Postoperative pain was assessed by measuring morphine consumption and visual analog scale (0-100 mm) pain scores at rest. Patients in the preemptive group had significantly lower morphine consumption on postoperative Days 1 and 2. No significant intergroup differences were seen in the pain scores throughout the study period. Preemptive ketamine decreased postoperative opioid requirements, which was observed long after the normal expected duration of ketamine.