Optimizing the Use of Ketamine to Reduce Chronic Postsurgical Pain

Purpose

The study utilizes a 3-arm placebo-controlled RCT to study the effectiveness of ketamine in reducing chronic post-mastectomy pain. Participants randomized to the first arm will receive a 0.35 mg/kg dose after induction, followed by a 0.25 mg/kg/hr infusion during surgery (up to a maximum of 6 hours) and continued for 2 hours postoperatively. Participants in the second arm will receive a single dose of 0.6 mg/kg of ketamine in the post-anesthesia care unit, and the final group will serve as the control group and receive saline (no ketamine).

Condition

  • Chronic Postsurgical Pain

Eligibility

Eligible Ages
Over 18 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Woman 18 years of age or older - Undergoing elective breast surgery for oncologic indication as follows: unilateral or bilateral mastectomy, prophylacticmastectomy, +/- lymph node dissection, +/- immediate or delayed reconstruction. - No distant metastases

Exclusion Criteria

  • History of cognitive impairment or clinical signs of altered mental status (AMS) that may interfere with adherence to study procedures and/or participant safety. Clinical signs of AMS may include but are not limited to: confusion, amnesia, disorientation, fluctuating levels of alertness, etc. - Past ketamine or phencyclidine misuse or abuse - Schizophrenia or history of psychosis - History of post-traumatic stress disorder - Known sensitivity or allergy to ketamine - Liver or renal insufficiency - History of uncontrolled hypertension, chest pain, cardiac arrhythmia, stroke, head trauma, intracranial mass or hemorrhage, glaucoma, porphyria, uncontrolled thyroid disease, or other contraindication to ketamine - Lamotrigine, alfentanil, physostigmine, or 4-aminopyridine use - Currently Pregnant - Body mass index (BMI) equal to or greater than 41 - Non-English or non-Spanish speaker - Currently participating in another pain interventional trial - Unwilling to comply with all study procedures and be available for the duration of the study - Patient is American Society of Anesthesiologists (ASA) physical status 4, 5, or 6 - Patient has started or undergone hormone therapy for gender transition into male. - Patient scheduled for any bilateral (or greater) flap reconstruction

Study Design

Phase
Phase 3
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Supportive Care
Masking
Triple (Participant, Care Provider, Investigator)
Masking Description
Participants, study members, and treating clinicians will be blinded to intervention.

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Arm 1 Continuous ketamine infusion group
Continuous ketamine infusion (0.35 mg/kg after induction, followed by 0.25 mg/kg/hr until 2 hours after surgery) plus saline IV dose in post-anesthesia care unit
  • Drug: Continuous ketamine infusion
    Continuous ketamine infusion (0.35 mg/kg after induction, followed by 0.25 mg/kg/hr until 2 hours after surgery) plus saline IV dose in post-anesthesia care unit
Active Comparator
Arm 2 Ketamine + Saline group
Saline dose and infusion intraoperatively, then single-dose IV ketamine (0.60 mg/kg) in post-anesthesia care unit plus 2 hours of saline administration after surgery
  • Drug: Ketamine + Saline
    Saline dose and infusion intraoperatively, then single-dose IV ketamine (0.60 mg/kg) in post-anesthesia care unit plus 2 hours of saline administration after surgery
Placebo Comparator
Arm 3 Placebo group
Placebo, Saline dose and infusion intraoperatively, then saline IV dose in post-anesthesia care unit plus 2 hours of saline administration after surgery
  • Other: Placebo
    Placebo, Saline dose and infusion intraoperatively, then saline IV dose in post-anesthesia care unit plus 2 hours of saline administration after surgery

Recruiting Locations

University of Alabama at Birmingham
Birmingham, Alabama 35233
Contact:
Lily Gutnik, MD, MPH
205-934-3562
lgutnik@uabmc.edu

University of Arkansas
Little Rock, Arkansas 72205
Contact:
Jill Mhyre, MD
501-686-6119
JMMhyre@uams.edu

Rush University Medical Center
Chicago, Illinois 60612
Contact:
Asokumar Buvanendran, MD
312-942-3685
asokumar_buvanendran@rush.edu

Brigham and Women's Hospital - Harvard University
Chestnut Hill, Massachusetts 02467
Contact:
Kristin Schreiber, MD, PhD
617-732-9463
klschreiber@bwh.harvard.edu

Mayo Clinic
Rochester, Minnesota 55905
Contact:
William Hooten, MD
507-266-9670
hooten.william@mayo.edu

Washington University at St. Louis Medical Center
Saint Louis, Missouri 63110
Contact:
Simon Haroutounian, PhD, MSc
314-273-2240
sharout@wustl.edu

Montefiore Medical Center - Albert Einstein College of Medicine
Bronx, New York 10467
Contact:
Shamantha Reddy, MD, FASA
646-942-0519
SHREDDY@montefiore.org

NYU Langone Health (Tisch Hospital, Kimmel Pavilion)
New York, New York 10016
Contact:
KALPAS Study
kalpas@nyulangone.org

New York Presbyterian Columbia University Irving Medical Center
New York, New York 10032
Contact:
Bret Taback, MD
212-342-3681
bt2160@cumc.columbia.edu

Memorial Sloan Kettering Cancer Center
New York, New York 10065
Contact:
Joshua Mincer, MD, PhD
646-735-8059
mincerj@mskcc.org

University of Pittsburgh - Magee Women's Hospital
Pittsburgh, Pennsylvania 15213
Contact:
Grace Lim, MD, MS
412-641-2179
limkg2@upmc.edu

University of Texas - Southwestern Medical Center
Dallas, Texas 75390
Contact:
Gloria Cheng, MD
214-645-7011
Gloria.Cheng@UTSouthwestern.edu

University of Texas - MD Anderson Cancer Center
Houston, Texas 77030
Contact:
Juan Cata, MD
832-294-5900
JCata@mdanderson.org

University of Washington Medical Center
Seattle, Washington 98195
Contact:
Michele Curratolo, MD, PhD
206-543-7817
curatolo@uw.edu

More Details

NCT ID
NCT05037123
Status
Recruiting
Sponsor
NYU Langone Health

Study Contact

Jing Wang, MD, PhD
212-263-5072
Jing.Wang2@nyulangone.org

Detailed Description

This is a phase 3, multicenter, randomized, double-blind, placebo-controlled trial to study the effectiveness of ketamine in reducing PMPS. In a 3-arm, parallel-group study, approximately 750 adult women undergoing mastectomy or prophylactic mastectomy for oncologic reasons will be randomized to one of three arms. Participants in the first arm will receive continuous ketamine infusion starting after anesthetic induction (0.35 mg/kg dose after induction, followed by a 0.25 mg/kg/hr infusion during surgery (with a maximum infusion of 6 hours) plus a postoperative saline dose, and continuation of 0.25 mg/kg/hr ketamine infusion for 2 hours postoperatively). Participants in the second arm will receive a dose of saline after induction, followed by a saline infusion during the surgery plus a single dose of 0.6 mg/kg of ketamine in the PACU, and 2 hours of saline infusion after surgery. The final group will serve as the control group and receive an intraoperative dose of saline, followed by saline infusion plus a postoperative saline dose and 2 hours of saline infusion after surgery. Participants will be followed at 1 and 7 days and 1, 3, 6, and 12 months after surgery.