Authors: Wilson, Jenna et al.
Anesthesiology October 2025 | DOI: 10.1097/ALN.0000000000005649
This prospective randomized controlled trial evaluated whether intraoperative ketamine reduces acute postsurgical pain in women undergoing breast cancer surgery, while also examining whether baseline temporal summation of pain (a measure of central sensitization) influences ketamine’s efficacy.
A total of 225 patients were randomized to receive either intravenous ketamine or saline placebo during surgery. Participants completed preoperative assessments of demographic, psychological, and pain characteristics, and a subset underwent quantitative sensory testing to measure temporal summation of pain. Two weeks after surgery, pain severity and functional impact were evaluated through standardized questionnaires.
Across the full cohort, ketamine did not significantly reduce pain severity or impact compared to placebo. However, in exploratory analyses, patients who exhibited higher baseline temporal summation—a marker of central sensitization—showed lower postoperative pain scores when treated with ketamine. These findings suggest that ketamine’s analgesic benefit may be confined to individuals with preexisting heightened pain sensitivity rather than the general surgical population.
The study underscores the value of preoperative phenotyping to identify patients most likely to benefit from NMDA receptor antagonists like ketamine, supporting a precision-medicine approach to perioperative pain management.
What You Should Know
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Intraoperative ketamine did not reduce postoperative pain overall after breast cancer surgery.
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Patients with high baseline temporal summation (evidence of central sensitization) experienced meaningful pain relief with ketamine.
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Personalized assessment of pain sensitivity may help target ketamine use to patients most likely to benefit.
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