Impact of Ketamine on Opioid Use and Persistent Pain After Cytoreductive Surgery with Hyperthermic Chemotherapy

Juan P Cata,1,2 Pascal Owusu-Agyemang,1,2 Dhanalakshmi Koyyalagunta,3 German Corrales,1,2 Lei Feng,4 Keith Fournier2,3 1Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 3Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USACorrespondence: Juan P CataDepartment of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX, USATel +1 713-792-4582Fax +1 713-792-4582Email JCata@mdanderson.orgBackground: Persistent pain and opioid use can be devastating after cytoreductive surgery (CRS) and hyperthermic intraoperative chemotherapy (HIPEC).Methods: We conducted a retrospective study to investigate the impact of ketamine use on postoperative complications and persistent and chronic pain after CRS-HIPEC.Results: Ketamine reduced perioperative opioid use before and after implementation of recovery after surgery programs. Ketamine did not impact the formation of persistent and chronic pain formation and long-term opioid use. Postoperative complications and postoperative re-operations were independent predictors of persistent pain. Interestingly, the risk of having a complication was increased by 1% for every doubling in opioids used intraoperatively.Conclusion: Ketamine use reduces perioperative opioid consumption in patients undergoing CRS-HIPEC, but it is not associated with improvements in long-term opioid use and chronic pain.Keywords: chronic pain, cancer, neoplasm, opioids, ketamine, surgery, cytoreductive surgery