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Using ketamine to reduce a common and painful post-surgery complication

Lisa Coward and Dr Ashley Webb with research participant Marcus Mooney (centre).

Lisa Coward and Dr Ashley Webb with research participant Marcus Mooney (centre).

Chronic post-surgical pain – pain  that develops and persists for three or more months after an operation  – is now known to be one of the most common and debilitating postoperative complications.

Peninsula Health is taking part in a large multi-centre, randomised trial to investigate the effect intravenous ketamine given before and after surgical incision for up to 72 hours has on reducing chronic post-surgical pain in patients having non-cardiac thoracic surgery, major abdominal surgery and hip and knee arthroplasty or spinal surgery.

“Chronic post-surgical pain is a very important complication of major surgery which is under-recognised. Depending on the type of surgery, there is quite an alarming incidence, said to be around 10-15% with mastectomy surgery but around 60% with thoracic surgery,” explains Anaesthetist Dr Ashley Webb, who is leading the trial at Peninsula Health.

“The effects are debilitating and there are huge economic costs – this is pain that will last years into the future.”

Ashley and research coordinator Lisa Coward started recruiting patients in April 2018 for the National Health and Medical Research Council funded ROCKet (Reduction of Chronic Post-surgical Pain with Ketamine) Trial, which runs for four years.

“Eighty-seven Peninsula Health patients have taken part in the trial so far,” explains Lisa.

“Of the 17 sites participating in the trial, we are the highest recruiting hospital to date.”

This trial is the biggest investigation ever into the effect of using ketamine to prevent chronic post-surgical pain.

“Ketamine is a drug that has been around for a long time and is certainly known to be useful for treating acute pain, but there was a strong signal from the pilot study that fewer patients who had ketamine infusions went on to develop chronic pain,” says Ashley.

“Hence it was scaled up into this very large multi-centre study.”

As well as following up patients to find out if they were experiencing chronic post-surgical pain at three and twelve months after surgery, the study is investigating the impact such pain has on a patient.

“We ask a lot of questions about quality of recovery and quality of life after surgery because they are really important end points from a patient perspective,” says Ashley.

“The other aspect we are looking at is healthcare utilisation costs. Study participants give permission for the Medicare database to be used to look at how many GP visits, specialist visits and pain medication prescriptions they have in the 12 months after surgery.”

“It also looks at ‘over the counter medications’ as well as ‘days absent from work,’ covering the entire economic cost of chronic pain,” adds Lisa.

The outcome of the research has the potential to help the many thousands of people who have surgery and are at risk of developing chronic post-surgical pain, both in Australia and beyond.

“There is going to be a big benefit for both the individual and the health system as a whole if this study shows that using a relatively cheap drug like ketamine reduces chronic pain and the need for health interventions,” remarks Ashley.

+ The ROCKet Trial is a five-year, 4,884 patient, multi-centre, double-blind, placebo controlled, phase 3/4 randomised controlled trial of the effect of up to 72 hours of perioperative ketamine on the risk of development of chronic post-surgical pain, led by Principal Investigator A/Prof Philip Peyton, University of Melbourne.

+ Investigating what can be done to stop patients developing chronic pain after surgery was voted one of the top ten research priorities for Anaesthesia and Perioperative Care by UK health practitioners in 2015.

This article was first published in the 2019 Research Report.