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Chapter 72. The Role of Nonopioid Analgesic Infusions in the Management of Postoperative Pain

Perioperative IV ketamine in patients undergoing cervical and lumbar spine surgery has been shown to:

A. Have no effect on pain scores

B. Increase perioperative analgesic requirements

C. Improve patient satisfaction

D. Affect bone healing after spine surgery

C is correct. Perioperative IV ketamine in patients undergoing spine surgery has been shown to improve overall patient satisfaction.

A is incorrect. IV ketamine has been shown to decrease overall pain scores.

B is incorrect. IV ketamine decreases perioperative analgesic requirements, including opioids.

D is incorrect. Ketamine has not been shown to have any effect on bone healing.

Perioperative IV ketamine has not been shown to be beneficial in the setting of:

A. Postamputation pain

B. Epidural analgesia

C. Opioid tolerance

D. Burn patients

A is correct. IV ketamine infusion for 72 hours was not effective in reducing morphine consumption or in decreasing the incidence of stump allodynia. At 6-month follow-up, the incidences of phantom pain and stump pain did not show any statistical difference. Overall, ketamine is not known to reduce acute central sensitization or the incidence and severity of postamputation pain.

B is incorrect. The addition of IV ketamine to epidural analgesia has been shown to result in less morphine requirements and reduced area of hyperalgesia.

C is incorrect. The addition of IV ketamine in the perioperative setting appears to be beneficial in opioid-tolerant patients by decreasing both opioid requirements and pain scores.

D is incorrect. IV ketamine has demonstrated its analgesic efficacy in burns, with a reduction in secondary hyperalgesia, in comparison with opioid monotherapy. The combination of ketamine plus morphine resulted in the abolition of hyperalgesia in a study of 67 burn patients.

In the perioperative setting, IV lidocaine infusion has been shown to increase:

A. Inflammatory activity

B. Opioid requirement

C. Hospital length of stay

D. Rate of bowel function return

D is correct. IV lidocaine infusion has been shown to improve recovery by promoting a shorter duration of postoperative ileus.

A is incorrect. IV lidocaine has been shown to reduce surgery-induced immune changes and ...

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