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Submitted by Claudia Rocha (claudia.rocha@udesc.br) on 2018-03-15T16:54:10Z No. of bitstreams: 1 PGCA16MA213.pdf: 1442712 bytes, checksum: 89506b3035f7acc4dd2a3d494c07e5e8 (MD5) / Made available in DSpace on 2018-03-15T16:54:10Z (GMT). No. of bitstreams: 1 PGCA16MA213.pdf: 1442712 bytes, checksum: 89506b3035f7acc4dd2a3d494c07e5e8 (MD5) Previous issue date: 2016-10-27 / The surgical procedure mastectomy is the most appropriate treatment in cases of tumors of the mammary glands in female dogs. In addition to the drug combinations that seek multimodal anesthesia, the use of regional anesthesia techniques can also be used for this procedure. Blockade of the transversus abdominis plane (TAP) is a regional anesthetic technique designed to desensitize the branches that innervate the abdominal muscles, abdominal subcutaneous tissue and parietal peritoneum, with the deposition of the local anesthetic in the fascia between the internal oblique and transversus abdominis identified by ultrasound. The objective of this study was to evaluate the analgesic effectiveness of the TAP block, associated with intercostal blocks in trans and postoperative of animals submitted at radical unilateral mastectomy, compared to analgesia with continuous infusion of morphine, lidocaine, and ketamine (MLK), and testing sensitivity to rescue analgesics three different methods for assessing acute pain in dogs: Visual Analogue Scale (VAS), Glasgow Composite pain Scale and Melbourne Scale. The project was carried out from April to July of 2016, with animals from the clinical routine Veterinary Hospital HCV-CAV / UDESC. Three groups were used with 6 dogs each: TAP Group, submitted to the transversus abdominis block associated with intercostal blocks, performed with bupivacaine without vasoconstrictor; Group MLK subjected to intravenous infusion of morphine, lidocaine and ketamine (MLK) during surgeries; and control group, with animals that did not receive any locoregional anesthesia or analgesics infusion. The application of analgesic rescues with fentanyl was higher in the control group during the trans-operative assessment and did not differ between TAP and MLK groups. In the postoperative assessments, there were no differences between the groups in relation to the request redemptions of morphine, however, Glasgow and EVA were more sensitive. The TAP block associated with intercostal blocks can replace the infusion of MLK in bitches submitted to unilateral mastectomy / O procedimento cirúrgico de mastectomia é o tratamento mais indicado nos casos de tumores de glândulas mamárias em cadelas. Além das associações medicamentosas que buscam a anestesia multimodal, o emprego de técnicas de anestesia locorregional também podem ser utilizadas para esse procedimento. O bloqueio do plano transverso abdominal (TAP), é uma técnica de anestesia regional projetada para dessensibilizar os ramos que inervam os músculos abdominais, tecido subcutâneo abdominal e peritônio parietal, por meio da deposição do anestésico local na fáscia entre o músculo oblíquo interno e transverso abdominal identificados através da ecografia. O objetivo deste trabalho, foi avaliar a eficiência analgésica do bloqueio TAP, associado aos bloqueios intercostais, no trans e pós-operatórios de animais submetidos à mastectomia unilateral radical, comparativamente à analgesia com infusão continua de morfina, lidocaína e cetamina (MLK), testando a sensibilidade ao resgate analgésicos de três diferentes métodos de avaliação de dor aguda em cães: Escala Visual Analógica (EVA), Escala Composta de Dor de Glasgow e Escala de Melbourne. O projeto foi desenvolvido no período de Abril a Julho do ano de 2016, com animais provenientes da rotina clínica do Hospital de Clínicas Veterinárias HCV-CAV/UDESC. Foram utilizados três grupos com 6 cadelas cada: Grupo TAP, submetido ao bloqueio transverso abdominal associado a bloqueios intercostais, realizados com bupivacaína sem vasoconstritor; Grupo MLK, submetido a infusão intravenosa de morfina, lidocaína e cetamina (MLK) durante o transoperatório; e Grupo controle, com animais que não receberam nenhum tipo de anestesia locorregional ou infusão de analgésicos. O requerimento de resgastes analgésico com fentanil, foi maior no grupo Controle durante a avaliação trans-operatória, e não diferiu entre os grupos TAP e MLK. Nas avaliações de pós-operatório, não houveram diferenças entre os grupos em relação ao requerimento de resgates com morfina, no entanto, Glasgow e a EVA mostraram-se mais sensíveis. O bloqueio TAP associado aos bloqueios intercostais, causa analgesia similar à infusão de MLK em cadelas submetidas a mastectomia unilateral

Made available in DSpace on 2016-01-26T18:55:39Z (GMT). No. of bitstreams: 1 Giulianne.pdf: 642952 bytes, checksum: b1065f2a240f35cc8466ace402a0ed40 (MD5) Previous issue date: 2014-03-31 / The aim of this study was to evaluate the analgesic effects of gabapentin as an adjunct in the control of postoperative pain in dogs undergoing mastectomy. In a blinded study, 20 female dogs (10.5±5 kg body weight) were randomly assigned to 2 groups of 10 animals each and received 60 min prior of the surgery, by oral route: 10mg kg-1 of gabapentin (Gabapentin) or placebo (Control). Pre-anesthetic medication was intramuscular (IM) acepromazine (0.03mg kg-1) in combination with morphine (0.3mg kg-1). Anesthesia was induced with intravenously (IV) propofol (dose effect) and maintained with isoflurane. Meloxicam (0.2 mg kg-1, IV) was administered five minutes before the surgical incision. The analgesic intra-operative support was provided by IV continuous rate morphine (0.1mg kg-1h-1). Heart rate, respiratory rate, systolic arterial blood pressure, oxycapnography and end-tidal concentration of isoflurane were evaluated during the surgery. Postoperative analgesia was assessed during the first 72 hours after the tracheal extubation using a Dinamic and Interative Visual Analog Scale (DIVAS) and modified Glasgow Composite Measure Pain Scale (modified-GCMPS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of DIVAS and/or 33% of GCMPS during the postoperative period. The cardiopulmonary variables, pain and sedation scores did not differ between groups. However, rescue analgesia was 40% less frequently for Gabapentin (6 of 10 dogs needs rescue analgesic, total of 9 rescued doses in the Gabapentin group) than in the Control group (8 of 10 dogs, total of 15 rescued doses in the Control group). It was concluded that the adjuvant gabapentin administration reduce the requirement for rescue opioid in dogs undergoing mastectomy / Objetivou-se avaliar a ação da gabapentina como adjuvante do controle da dor pós-operatória em cadelas encaminhadas à mastectomia. Foram avaliadas 20 cadelas, com peso médio de 10,5±5, distribuídas em dois grupos de dez animais cada: Gabapentina: tratamento com gabapentina (10mg kg-1) por via oral, 60 minutos antes da cirurgia, seguindo-se a administração da mesma dose a cada 24 horas, durante três dias subsequentes à cirurgia; Controle: tratamento placebo, administrado conforme descrito para o tratamento Gabapentina. Todos os animais foram tranquilizados com acepromazina (0,03mg kg-1), em associação à morfina (0,5mg kg-1), por via intramuscular. Vinte minutos após, foi iniciada a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1), que foi mantida até o término do procedimento cirúrgico. A indução e manutenção anestésicas foram realizadas com propofol (dose efeito, IV) e isofluorano, respectivamente. Meloxicam (0,2mg kg-1, IV), foi administrado cinco minutos antes da incisão cirúrgica. Durante o procedimento anestésico foram avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia, temperatura retal, concentração final inspirada e expirada de isofluorano. No período pós-operatório o grau de analgesia foi mensurado 30 minutos, 1, 2, 4, 8, 12, 18, 24, 32, 40, 48, 56, 64 e 72 horas após extubação traqueal utilizando-se a Escala Analógica Visual Interativa e Dinâmica (EAVID) e a Escala Composta de Glasgow Modificada (ECGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% do EAVID e/ou 33% do ECGM. O grau de sedação foi avaliado por sistema de escore. As variáveis cardiorrespiratórias e os escores de dor e de sedação não diferiram entre os tratamentos. Porém, no período pós-operatório, analgesia de resgate foi 40% menos frequente no grupo Gabapentina (6 de 10 cães necessitaram de resgate analgésico, totalizando 9 resgates no grupo Gabapentina) em relação ao Controle (8 de 10 cães necessitaram de resgate analgésico, totalizando 15 resgates no grupo Controle). Conclui-se que a administração adjuvante da gabapentina reduziu o requerimento de morfina para controle da dor no período pós-operatório em cadelas pós-mastectomia

Made available in DSpace on 2016-07-18T17:53:12Z (GMT). No. of bitstreams: 1 Giulianne.pdf: 642952 bytes, checksum: b1065f2a240f35cc8466ace402a0ed40 (MD5) Previous issue date: 2014-03-31 / The aim of this study was to evaluate the analgesic effects of gabapentin as an adjunct in the control of postoperative pain in dogs undergoing mastectomy. In a blinded study, 20 female dogs (10.5±5 kg body weight) were randomly assigned to 2 groups of 10 animals each and received 60 min prior of the surgery, by oral route: 10mg kg-1 of gabapentin (Gabapentin) or placebo (Control). Pre-anesthetic medication was intramuscular (IM) acepromazine (0.03mg kg-1) in combination with morphine (0.3mg kg-1). Anesthesia was induced with intravenously (IV) propofol (dose effect) and maintained with isoflurane. Meloxicam (0.2 mg kg-1, IV) was administered five minutes before the surgical incision. The analgesic intra-operative support was provided by IV continuous rate morphine (0.1mg kg-1h-1). Heart rate, respiratory rate, systolic arterial blood pressure, oxycapnography and end-tidal concentration of isoflurane were evaluated during the surgery. Postoperative analgesia was assessed during the first 72 hours after the tracheal extubation using a Dinamic and Interative Visual Analog Scale (DIVAS) and modified Glasgow Composite Measure Pain Scale (modified-GCMPS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of DIVAS and/or 33% of GCMPS during the postoperative period. The cardiopulmonary variables, pain and sedation scores did not differ between groups. However, rescue analgesia was 40% less frequently for Gabapentin (6 of 10 dogs needs rescue analgesic, total of 9 rescued doses in the Gabapentin group) than in the Control group (8 of 10 dogs, total of 15 rescued doses in the Control group). It was concluded that the adjuvant gabapentin administration reduce the requirement for rescue opioid in dogs undergoing mastectomy / Objetivou-se avaliar a ação da gabapentina como adjuvante do controle da dor pós-operatória em cadelas encaminhadas à mastectomia. Foram avaliadas 20 cadelas, com peso médio de 10,5±5, distribuídas em dois grupos de dez animais cada: Gabapentina: tratamento com gabapentina (10mg kg-1) por via oral, 60 minutos antes da cirurgia, seguindo-se a administração da mesma dose a cada 24 horas, durante três dias subsequentes à cirurgia; Controle: tratamento placebo, administrado conforme descrito para o tratamento Gabapentina. Todos os animais foram tranquilizados com acepromazina (0,03mg kg-1), em associação à morfina (0,5mg kg-1), por via intramuscular. Vinte minutos após, foi iniciada a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1), que foi mantida até o término do procedimento cirúrgico. A indução e manutenção anestésicas foram realizadas com propofol (dose efeito, IV) e isofluorano, respectivamente. Meloxicam (0,2mg kg-1, IV), foi administrado cinco minutos antes da incisão cirúrgica. Durante o procedimento anestésico foram avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia, temperatura retal, concentração final inspirada e expirada de isofluorano. No período pós-operatório o grau de analgesia foi mensurado 30 minutos, 1, 2, 4, 8, 12, 18, 24, 32, 40, 48, 56, 64 e 72 horas após extubação traqueal utilizando-se a Escala Analógica Visual Interativa e Dinâmica (EAVID) e a Escala Composta de Glasgow Modificada (ECGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% do EAVID e/ou 33% do ECGM. O grau de sedação foi avaliado por sistema de escore. As variáveis cardiorrespiratórias e os escores de dor e de sedação não diferiram entre os tratamentos. Porém, no período pós-operatório, analgesia de resgate foi 40% menos frequente no grupo Gabapentina (6 de 10 cães necessitaram de resgate analgésico, totalizando 9 resgates no grupo Gabapentina) em relação ao Controle (8 de 10 cães necessitaram de resgate analgésico, totalizando 15 resgates no grupo Controle). Conclui-se que a administração adjuvante da gabapentina reduziu o requerimento de morfina para controle da dor no período pós-operatório em cadelas pós-mastectomia

The opioid epidemic is a public health crisis in the United States that impacts the lives of millions of people. There is a need for interventions aimed at minimizing opioid usage in clinical settings. The perioperative care period – consisting of the time before, during, and after surgery – is a time where interventions can be made in surgical and anesthesia practice to reduce the number of opioids used. Surgery and anesthesia are two areas where patients have traditionally been introduced to prescription opioids for the first time. Enhanced Recovery After Surgery pathways have been designed to integrate and improve surgical care for patients resulting in decreased length of stay in the hospital for surgical patients. Enhanced Recovery After Surgery pathways have also explored reducing opioid use during surgical care. Multimodal Analgesia and Opioid Free Anesthesia are two methods that have been researched and shown to be successful in limiting the perioperative use of opioids. Multimodal Analgesia and Opioid Free Anesthesia both reduce total perioperative opioid use and manage pain as effectively as opioids.

Methadone and ketamine have been used in neuropathic pain management, but the benefits of the association of both drugs are uncertain. Aiming to enhance the analgesic efficacy and to reduce the occurrence of adverse-effects, an oral solutionof methadone plus ketamine was tested in patients suffering of neuropathic pain of different etiologies and resistant to other analgesics. All patients were treated in the Clinical Care & Pain Management of Santa Maria University Hospital (HUSM) between October 2006 and March 2008. Pain (primary aim) was analyzed before and several times after starting the treatment, through the visual analogical scale (VAS), allodynia and burning or shooting pain evaluation. The development of adverse-effects (secondary aim), such as somnolence, nausea, vomit, dizziness, hallucination, constipation and headache, was also investigated. The first part of this thesis presented the case report of 18 neuropathic pain patients treated with the oral solution of methadone plus ketamine during 6 months.Except for one patient that discontinued the treatment due to intolerable adverse effect, all patients reported pain relief and lowprevalence of adverse effects throughout the treatment. The second part of this thesis presents arandomized, double-blind study conducted with 37 neuropathic patients. Patients were randomly assigned in three treatment groups: methadone group (n=13), ketamine group (n=11) and methadone plus ketaminegroup (n=13). All patients received the designated treatment by oral route, during 3 months. Methadone, ketamine or methadone plus ketamine treatmentgradually (better effect in 30 than in 7 days) and largely (inhibition of about 70% at the end of treatment) reduced the level of neuropathic pain (VAS) with nodifference between the treatment groups.The proportion of patients presenting burning or shooting pain was similarly reduced in all treatmentgroups, but the prevalence of allodynia was significantly reduced only in ketamine group. Excepted for the somnolence that was more prevalent in methadone and methadone plus ketamine groups, the prevalence of the adverse effects was very similar in all treatment groups. All together, the present data show that the combination of methadone plus ketamine was effective to reliefneuropathic pain resistant to other analgesics, though the combination of the two drugs did not show superior efficacy than those reached by methadone or ketamine alone. This study strengthens the use of methadone or ketamine as alternatives to treat neuropathic pain. The drug of choice, however, should be based on the patient background. / Metadona e cetamina têm sido usados no tratamento da dor neuropática, mas os benefícios da associação das duas drogas são desconhecidos. Com o objetivo de melhorar a eficácia analgésica e reduzir a ocorrência de efeitos adversos, uma solução oral de metadona mais cetamina foi testada em pacientes que sofrem de dor neuropática de diferentes etiologias e resistentes a outros tipos de tratamento. Todos os pacientes foram tratados no ambulatório da dor do Hospital Universitário de Santa Maria (HUSM) entre outubro de 2006 e março de 2008. A dor foi analisada antes e várias vezes depois de iniciar o tratamento, através da escala visual analógica (EVA), bem como alodinia, dor em queimação e/ou em choque. Efeitos adversos, como sonolência, náuseas, vômitos, tontura, alucinação, constipação e dor de cabeça, também foram investigados. A primeira parte desta tese apresenta um relato de caso de 18 pacientes com dor neuropática, submetidos ao tratamento com a solução oral de metadona mais cetamina durante seis meses. Exceto para um paciente que descontinuou o tratamento devido a efeitos adversos intoleráveis, todos os pacientes relataram alívio da dor e de baixa prevalência de efeitos adversos ao longo do tratamento. A segunda parte desta tese apresenta um estudo duplo-cego randomizado, realizado com 37 pacientes apresentando dor neuropática de diferentes etiologias. Os pacientes foram divididos aleatoriamente em três grupos de tratamento: grupo metadona (n = 13), grupo cetamina (n = 11) e grupo metadona mais cetamina (n = 13). Todos os pacientes receberam o tratamento designado por via oral, durante 3 meses. O tratamento com metadona, cetamina ou metadona mais cetamina, gradualmente (melhor efeito em 30 do que em 7 dias) e em grande parte (inibição de cerca de 70% no final do tratamento) reduziu o nível de dor neuropática sem apresentar diferença significativa entre os grupos. A dor em queimação ou em choque apresentada pelos pacientes foi igualmente reduzida em todos os grupos de tratamento, mas a prevalência de alodinia foi significativamente reduzida apenas no grupo cetamina. A sonolência foi mais prevalente nos grupos da metadona e metadona mais cetamina, a manifestação dos demais efeitos adversos foi muito semelhante em todos os grupos de tratamento.

nÃo hà / A s(+)cetamina à o isÃmero levÃgiro da cetamina, antagonista do receptor NMDA para glutamato que està envolvido na gÃnese e manutenÃÃo do processo doloroso. A analgesia multimodal consiste na utilizaÃÃo de combinaÃÃo de fÃrmacos objetivando controle adequado da dor com reduÃÃo dos efeitos adversos. O objetivo deste estudo foi avaliar a eficiÃncia da s(+)cetamina isoladamente e da associaÃÃo morfina/cetamina comparadas à morfina isoladamente combinadas a mistura enantiomÃrica de bupivacaÃna (R75l25%) na anestesia peridural e analgesia pÃs-operatÃria em pacientes submetidas à histerectomia abdominal. Foi realizado estudo prospectivo, duplo cego e aleatÃrio, com aprovaÃÃo do Comità de Ãtica e Pesquisa da Universidade Federal do CearÃ. Participaram do estudo 36 pacientes ASA I ou II com idade de 20 a 60 anos submetidas à histerectomia abdominal com anestesia peridural. As pacientes foram alocadas em trÃs grupos: Grupo 1 - Grupo Cetamina (GC): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada à s(+)cetamina; Grupo 2 â Grupo Morfina (GM): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada à morfina e Grupo 3 - Grupo Cetamina/Morfina(GCM): administraÃÃo de mistura enantiomÃtrica (R75-S25) de bupivacaÃna associada à morfina e s(+)cetamina. Foram avaliados nÃvel de bloqueio motor e sensitivo, grau de sedaÃÃo e parÃmetros hemodinÃmicos: pressÃo arterial e frequÃncia cardÃaca a cada 15 minutos durante a cirurgia. No perÃodo pÃs-operatÃrio foi avaliado o consumo de analgÃsicos em 6 e 24 horas, alÃm da incidÃncia de nÃuseas, vÃmitos e prurido. A anÃlise estatÃstica foi realizada utilizando os softwares graphpad prisma 4.0 e Excel 2007. NÃo houve diferenÃa entre a idade, tempo cirÃrgico e o estado fÃsico (ASA) entre os grupos (p<0,05). A frequÃncia cardÃaca e pressÃo arterial mantiveram-se dentro dos valores estabelecidos como normal sem variaÃÃo significativa entre os grupos. A avaliaÃÃo da incidÃncia de efeitos adversos (nÃuseas, vÃmitos e prurido) nÃo foi diferente entre os grupos. A analgesia pÃs-operatÃria avaliada por consumo de analgÃsicos nas primeiras 6 horas nÃo foi diferente entre os grupos. Houve maior grau de bloqueio motor no grupo Cetamorf no tempo T15. Houve conversÃo para anestesia geral em 4 pacientes por falha de bloqueio, nos grupos cetamina-morfina (02 pacientes) e morfina (02 pacientes). Os dados sugerem que a adiÃÃo de s(+)cetamina e morfina nas doses avaliadas à segura, eficaz e permite a reduÃÃo de 50% na dose da morfina epidural mantendo-se o perfil de controle de dor no pÃs operatÃrio. No entanto, nÃo se verificou reduÃÃo da incidÃncia de nÃuseas, vÃmitos e prurido. / The association of drugs with different mechanisms of action in the dorsal horn of the spinal cord decreases postoperative pain, with a reduction in the incidence of side effects. The aim of this study was to evaluate some intraoperative parameters as well as postoperative analgesia and sedation by epidural morphine, S(+)ketamine and S(+) ketamine- morphine associated with Bupivacaine Enantiomeric Mixture (R75L25%) for abdominal hysterectomy. In this prospective, randomized, and double-blinded clinical trial, the efficacy and safety of the administration of epidural S(+)ketamine alone or with morphine were compared with epidural morphine alone (control group) for efficacy and safety comparisons after abdominal hysterectomy. 36 female patients, physical status ASA I and II, participated in this study. These patients were randomly allocated to one of the three treatment groups for having the following drugs administered epidurally: 1. Ketamine Group - Bupivacaine Enantiomeric Mixture (R75L25%) associated with S(+) ketamine (0.4 mg.kg-1); 2. Ketamine-Morphine Group - Bupivacaine Enantiomeric Mixture (R75L25%) associated S(+) ketamine (0.4 mg.kg-1) and morphine (1 mg) 3. Morphine Group, Bupivacaine Enantiomeric Mixture (R75L25%) was associated with morphine (2mg). During the intraoperative period the parameters analyzed were: blood pressure, heart rate, motor blockade level, sensitive level, intraoperative use of vasoconstrictor and sedation level. The time interval between each dada collection was 15 minutes. In the postoperative period, analgesia were evaluated using analogue visual scale 2h, 6h and 24h after the end of the surgery as well as the total amount of analgesics drugs requirement during the first 24 postoperative hours. Values were analyzed statistically using GraphPad Prisma 4.0 and Excel 2007. There were no differences between the three groups with respect to age, sex, weight, or duration of the surgical procedures (p<0,05). No differences were found between the groups during intraoperative analysis related to blood pressure, heart rate, Ramsay scores, vasoconstrictor use, and sensitive blockade level. Bromageâs scores were lower in the morpine/s+ketamine group during the first fifteen minutes analysis. Sedation scores were similar in both groups. The epidural blockade alone was not enough for surgical anesthesia resulting in conversion to general anesthesia in 4 patients who belong to Ketamine-morphine (02 patients) and Morphine (02 patients) groups, respectively. None of the patients in either group developed respiratory depression. Other side effects, such as pruritus, nausea, and vomiting, were also similar in both groups. The addiction of s(+) ketamine was safety and efficient to Bupivacaine Enantiomeric Mixture (R75L25%) in comparison with morphine.

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a thorough literature review focusing on intravenous ketamine as an adjunct to standard opioid-based analgesia for postoperative pain. Four systematic reviews published in the last 10 years support the safety and efficacy of ketamine when administered intravenously in sub-anesthetic doses. The purpose of this project was to provide evidence-based education to anesthesia providers regarding the benefits of ketamine and follow-up to evaluate for evidence of changes in practice after the educational At a large community hospital data concerning ketamine utilization by anesthesia providers as a component of multimodal analgesia was collected for a six-month period, including three months pre- and three months post-educational intervention. Despite various methods utilized to present evidence regarding the safety and efficacy of ketamine, the results of this study demonstrated no significant change in practice. Based upon the extensive published literature the evidence is compelling that the addition of a sub-anesthetic (0.5 mg/kg) dose of ketamine to the surgical patient’s operative pain management plan would improve comfort and decrease opioid-related side effects with minimal negative impact.