Intravenous S-ketamine’s analgesic efficacy in third molar surgery. A randomized placebo-controlled double-blind clinical trial

• Published in: British journal of pain 2024-04, Vol.18 (2), p.197-208
• Main Authors: Eriksson, Lars B, Gordh, Torsten, Karlsten, Rolf, LoMartire, Riccardo, Thor, Andreas, Tegelberg, Åke
• Format: Article
• Language: English
• Subjects: intravenous; oral surgery; pain; pain management; postoperative pain; S-Ketamine pain; sedation
• ISSN: 2049-4637; 2049-4645; 2049-4645
• DOI: 10.1177/20494637231222327

Background In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred. Methods The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline). Results A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group. Conclusions Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.