KETAMINE

The use of ketamine as an analgesic

The use of ketamine as an analgesic

Introduction

The purpose of this literature review is to focuson the use of ketamine as an adjunct to anaesthesia regime in Enhanced Recovery Programmes for patients undergoing Joint replacements given the increase in the volumes of the replacements of the joint being conducted in the UK. This literature review will look at what is an Enhanced Recovery programme (ERP) and indeed its place in a modern NHS. Specifically Focussing on effective pain management within ERP and looking at ketamine as a pre-operative analgesic, the pharmodynamics and pharmokenetics of this drug and the implications and proposed recommendations for practice within ERP for elective arthroplasty surgical pathways will be examined.

Discussion

Joint arthroplasty is a procedure involving surgery, which is performed to improve function, reduce pain and correct deformity, (Samuel et al 2010 pp 1532-1543). The annual report of the National Joint registry undertaken in 2011 identifies more than seventy thousand primary procedures pertaining to hip replacement and 7 knee replacements,at a primary level completed in the UK. Same increase in the happening of these procedures is reflected in arthroplasty surgical numbers, internationaly. (Mazin et al, 201).Total use of arthroplasty of knee in the USA almost doubled from 1999 to 2008, and this was identified across the spectrum in patients' age and demographic, (Luring et al, 2008 pp 928-934). This rise cannot simply be understood by growth of population or for that matter, the obesity epidemic, and is likely to be augmented by rising incidences of knee injuries resulting from sports and the rising indications relating to the total knee replacement, (Losina et al,2012).

The ever increasing need for arthroplasty surgery combined with advancements in surgical and anaesthetic technique has made it possible to operate on patients with an increased co morbity profile which in previous years may have been deemed unfit for elective surgery. (Nicholas et al, 2011; Wainright, 2010). Whilst this is of benefit to patients, the increase in demand puts further pressure on clinical, nursing and therapy staff and hospital management for producing the best results with an early functional recovery and short period of stay. (Wainright et al, 2010; Ibrahim, 2013).

Yet, an increase in quantity must not negate from the quality of care delivered to patients. Surgical pathways and managerial frameworks need to accommodate a variety of pre-operative interventions using evidence based practice to meet both patient expectations and achieve service delivery outcomes. High Quality Care for All, places quality and improvement at the very heart of the NHS in England. (DOH, 2008). Quality of health care can be categorised into three components: Patient safety, patient experience and effectiveness of care. The Enhanced Recovery Programme (ERP) encompasses all aspects of this definition of quality of health care and is a combination of evidence based elements, that seek to reduce postoperative stress responses and organ dysfunction so that patients recover more quickly and are designed to maximise patient outcomes, (Abraham et al,2011; NHS, ...