tant. Ketamine infusions help to knock down the pain in chronic opi-
oid users. It's not a new concept, but a lot of centers are making the
old new again and giving ketamine to narcotic users coming in for sur-
gery.
Dr. Wagner Ketamine temporarily reverses the tolerance that patients
have to opioid medications. It makes additional opioid doses more
effective and is a very good adjunctive non-narcotic medication that
can be used to replace, to some extent, the effect of opioids. We use it
intraoperatively and run infusions post-operatively for a day or so.
Dr. Viscusi. It really is incredibly useful and effective in patients with
opioid tolerance. You may use a bolus administration or bolus plus
infusion. It's generally very well tolerated and has a clear impact on
post-op pain.
How do you envision pain management
evolving in the coming years?
Dr. Snyder We know surgery causes pain, but what really causes it?
How does pain move up and down the patient's nervous system from
the point of surgery to the brain, and what medicine can be used to
mitigate that? Those are questions to explore.
Dr. Wagner The Holy Grail is to provide pain relief without blocking
patients' strength, to give them a pain sensory block while leaving
them with intact sensation. It'd be great to separate pain relief from
the euphoric, addictive and tolerant aspects of opioids — to get the
effects without the side effects.
Dr. Snyder When the FDA allows it, we hope to conduct research on
combining tissue injections with adductor blocks, which would result
in soft tissue envelope control and more predicable pain management.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015
