In fibromyalgia patients undergoing knee or hip replacement surgery, low-dose, intraoperative ketamine appeared to reduce the need for post-surgical opioid therapy, researchers said here.

Based on a retrospective review, the dose requirement for oral morphine to control pain in the 48 hours after surgery was 135 mg for patients who received intraoperative ketamine versus 250 mg for those who did not (P=0.054), reported Jonathan Day, MD, a major in the U.S. Air Force, who led the study while a fellow in anesthesiology at the Mayo Clinic in Jacksonville, Fla.

"Despite the small sample size – 15 patients who were not given ketamine versus 10 patients getting the sub-anesthetic dose of ketamine -- this was marginally statistically significant and consistent with anecdotal reports," Day said in a presentation at the American Academy of Pain Medicine meeting.

Ketamine is a dissociative anesthetic and has been used in human and veterinary medicine since 1963.

After hearing anecdotal reports from fibromyalgia patients of fibromyalgia symptom improvement after receiving ketamine, Day's group decided to analyze patient records at their clinic to confirm these reports.

They performed a chart review of 25 consecutive patients with fibromyalgia. Ten of the patients were undergoing total hip arthroplasty and 15 were having total knee arthroplasty. The same regional anesthetic blockade was used in all cases. Five patients in each surgical group were also given low-dose ketamine infusion.

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