Perioperative ketamine does not prevent chronic pain after thoracotomy

Eur J Pain. 2009 May;13(5):497-505. doi: 10.1016/j.ejpain.2008.06.013. Epub 2008 Sep 9.


Thoracotomy is often responsible for chronic pain, possibly of neuropathic origin. To confirm preclinical studies, the preventive effects of perioperative ketamine were tested in a randomized, double-blind, placebo-controlled clinical trial on persistent neuropathic pain after thoracotomy. Eighty-six patients scheduled for thoracotomy under standardised general anaesthesia were randomised to receive either ketamine (1 mg kg(-1) at the induction, 1 mg kg(-1) h(-1) during surgery, then 1 mg kg(-1) during 24 h; n=42) or normal saline (n=44). Postoperative analgesia included a single dose of intrapleural ropivacaine, intravenous paracetamol and nefopam, and patient-controlled intravenous morphine. Vital parameters and analgesia were recorded during the 48 first postoperative hours. Seventy-three patients were followed up. The patient's chest was examined 1-2 weeks, 6 weeks and 4 months after surgery. At the last two observations, spontaneous pain score over a one-week period (visual analogue scale), neuropathic pain score (NPSI), and intake of analgesics, were assessed. No drug affecting neuropathic pain (except opiates) was given during the follow-up. Two patients in each group were lost to follow-up after the 6 week visit. Ketamine improved immediate postoperative pain, but the groups were similar in terms of neuropathic pain and intake of analgesics, 6 weeks (NPSI score: ketamine: 1.25 [0-4.125]; placebo: 1 [0-4]) and 4 months after surgery. Thus, ketamine given in 24-h infusion failed to prevent chronic neuropathic pain after thoracotomy. Other perioperative preventive long-lasting treatments or techniques could be tested in this context.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Analgesics, Non-Narcotic / administration & dosage
  • Anesthetics, Dissociative / administration & dosage
  • Anesthetics, Local / administration & dosage
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Humans
  • Intraoperative Care / methods
  • Intraoperative Care / statistics & numerical data*
  • Ketamine / administration & dosage*
  • Male
  • Middle Aged
  • Narcotics / administration & dosage
  • Neuralgia / drug therapy
  • Neuralgia / etiology
  • Neuralgia / prevention & control
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / prevention & control
  • Placebos
  • Postoperative Care / methods
  • Postoperative Care / statistics & numerical data
  • Preoperative Care / methods
  • Preoperative Care / statistics & numerical data
  • Thoracotomy / adverse effects*
  • Treatment Failure


  • Analgesics, Non-Narcotic
  • Anesthetics, Dissociative
  • Anesthetics, Local
  • Narcotics
  • Placebos
  • Ketamine