Noxious stimuli occurring intraoperatively and postoperatively generate central
sensitization, decreasing pain thresholds and ultimately increasing analgesic requirements.
The pathophysiology of central sensitization is thought to involve excitatory amino acid
receptors such as N-methyl-d-aspartate (NMDA) (1, 2). Ketamine is a N-methyl-d-aspartate
(NMDA) receptor antagonist that has been shown to be useful in the reduction of acute
postoperative pain and analgesic consumption in a variety of surgical interventions (3).
Spine surgery provides a unique opportunity to evaluate the preemptive and preventative
impact of ketamine on the primary end points of postoperative 24 and 48 hour opioid
consumption in patients with chronic pain. The goal of this IRB approved double blinded,
prospective, randomized placebo controlled trial is to quantify the preemptive and
preventative analgesic effects of ketamine infusions in this patient population. Such insight
may lead to better pain control, improved satisfaction, and ultimately a reduction in
side-effects related to postoperative opioid use.