S-Ketamine may lower pain and enhance recovery after open gynecological surgery

China:  Researchers from China found that S-Ketamine usage has shortened the patients' flatus duration thus enhancing the post-operative recovery and also reducing the 24h postoperative pain in patients undergoing open gynecological surgery. The trial results were published in the journal BMC surgery. 

Recent research suggests the use of ketamine as part of multimodal analgesia for treating acute pain with fewer side effects. Past literature has suggested that S-Ketamine can ameliorate postoperative pain. Hence researchers from China conducted a study to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery. 

Nearly 100 gynecological patients undergoing an open abdomen surgery were randomly divided into an S-ketamine group (group S) or placebo group (0.9% saline; group C). In group S anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion, and in group C it was with sevoflurane and remifentanil-propofol target-controlled infusion. Patient-controlled intravenous analgesia (PCIA) pump was connected to all patients at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The time of the first postoperative flatus was the primary outcome, and the secondary outcome was the postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded. 

Key findings: 

• The time of the first postoperative flatus was significantly reduced in group S than in group C.
• The patient’s visual analog scale (VAS) pain score was significantly lower in group S than in group C, 24 h after surgery at rest (p = 0.032).
• No differences were found in sufentanil consumption within the first postoperative 24 h and postoperative complications related to PCIA between the two groups. 

Thus, in patients undergoing open gynecological surgery, S-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain. 

Further reading: Zhang, T., Yue, Z., Yu, L. et al. S-ketamine promotes postoperative recovery of gastrointestinal function and reduces postoperative pain in gynecological abdominal surgery patients: a randomized controlled trial. BMC Surg 23, 74 (2023).  https://doi.org/10.1186/s12893-023-01973-0