ketamine spinals?

[BIGphysician]

Anyone ever use ketamine in a spinal? What is the indication for this?

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[Arch Guillotti]

Anyone ever use ketamine in a spinal? What is the indication for this?

No.

 

[Noyac]

Why do you ask?

 

[deleted59964]

no preservative free ketamine here

 

[BIGphysician]

I've been hearing about it in some reading lately, I guess it has been used to potentate morphine in lamina 2 of the DRG and decreases post-op pain requirements. I've never heard of it in practice though.

 

[Urzuz]

To me this seems to be an elegant, sexy solution to something that isn't a problem.

You know what also potentiates morphine and decreases postop opioid requirements? IV ketamine intraoperatively.

 

[Noyac]

Then July place I've heard of this is in pain management as an idea for chronic pain management. I've never seen it done. I think some may have put it in Intrathecal pain pumps.

 

[BLADEMDA]

Eur J Anaesthesiol. 2006 Dec;23(12):1018-24. Epub 2006 Jul 7.
A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery.
Unlugenc H1, Ozalevli M, Gunes Y, Olguner S, Evrüke C, Ozcengiz D, Akman H.
Author information

Abstract
BACKGROUND:
In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia.

METHODS:
Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg-1 of S(+) ketamine (1.0 mL) in Group K (n =30) or 25 microg (1.0 mL) of fentanyl in Group F (n =30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia.

RESULTS:
The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001).

CONCLUSION:
In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg-1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.

 

[BLADEMDA]

http://njmr.in/uploads/1-2_71-751.pdf

i won't be using intrathecal ketamine anytime soon

 

[Psai]

http://njmr.in/uploads/1-2_71-751.pdf

i won't be using intrathecal ketamine anytime soon

is this a legitimate journal?

 

[Noyac]

Those Europeans can and will do just about anything without any ear of repercussions.
I'm so jealous.

 

[BLADEMDA]

is this a legitimate journal?

Who else would inject intrathecal ketamine into a human being?

 

[Noyac]

^^^exactly.

 

[painstop]

^^^exactly.

There must have been a brave soul who dared to add fentanyl to the local anesthetic in spinal years ago...at some point the jump to human patients will happen whether it is via the FDA pre-clinical-Phase 1-2-3 ten year track or the "off-label" "I'm a doctor with some permission from my hospital" track (obviously easier in foreign countries).

 

[Planktonmd]

One of my partners who does mainly pain has been adding Ketamine to the intrathecal pumps for years with excellent results.

 

[epidural man]

intrathecal ketamine = apoptosis of nerve cells.

The authors that showed this have some pretty cool pictures.

 

[dhb]

Those Europeans can and will do just about anything without any ear of repercussions.
I'm so jealous.

Published in the European journal but often these crazy studies come from Turkey (as is the case here i believe) thus not submitted to EU regulations