La kétamine est-elle vraiment indiquée en périopératoire et pourquoi ?

Ketamine is the gold standard of anti-hyperalgesics. It is the one with the best efficacy-to-tolerance ratio. It is the only one with both short- and long-term value. The use of low-dose ketamine during surgery (< 0.5 mg/kg) reduces acute pain intensity for 24 hours and decreases the morphine demand by 15 mg on average, over 24 hours. It thus prevents the occurrence of nausea and vomiting. The effect on acute pain is all the more marked when it applies to severely painful surgeries. Prolongation of postoperative ketamine administration increases the risk of hallucinations without significantly increasing the analgesic effect. Ketamine reduces the incidence of chronic post-surgical pain by 30%, three months after surgery. There is no evidence that ketamine should be combined with other anti-hyperalgesics.