Ketamine Infusion in Post-Surgical Pain Management after Head and Neck Surgery: A Retrospective Observational Study

Vincenzo Pota1, *, Maria B. Passavanti1, Caterina Aurilio1, Manlio Barbarisi2, Luca G. Giaccari1, Umberto Colella3, Marco Fiore1, Giuseppe S. R. C. Mangoni di Santostefano1, Pasquale Sansone1, Maria C. Pace1
1 Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy
2 Dipartimento Multidisciplinare di Specialità Medico-Chirurgiche e Odontoiatriche, Università degli Studi della Campania "Luigi Vanvitelli", Campania, Naples, Italy
3 Department of Anesthesia, AORN Monaldi Hospital, Napoli, Italy

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©2019 Pota et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Napoli, Italy; Tel: 00393664485084;



Head and neck cancer affects approximately 382,000 new patients per year worldwide with a significant portion undergoing surgical treatment. During postoperative period key elements in the Intensive Care Unit (ICU) are airway management and pain control.


We evaluated the average change of inpatient pain control using a Numerical Rating Score (NRS). We also evaluated the time of extubation after ICU admission recording the incidence of desaturation and the necessity of re-intubation. Secondary outcomes were the incidence of postoperative complications, included those narcotics-related, and the use of rescue analgesics.


In this retrospective observational study, we analyzed data of registry before and after we have changed our postoperative analgesic protocol from remifentanil infusion to ketamine infusion.


Medical records of 20 patients were examined. 10 patients received 0.5 mg/kg ketamine bolus at the end of surgery, followed by a continuous infusion of 0.25 mg/kg/h. All patients presented a significant decrease in pain intensity from the 4th to 48th postoperative hour (p < 0.05), but statically not a significant difference in NRS score was recorded between the two groups. Time to extubation was shorter in ketamine group compared to the remifentanil group (112.30 min ± 16.78 vs. 78 min ± 14.17; p < 0.05). Desaturation rate was 10% in the remifentanil group, while no case was recorded in the ketamine group.


The level of analgesia provided by ketamine and remifentanil was comparable. Ketamine was superior in ventilatory management of the patient with more rapid extubation and with no case of desaturation.

Keywords: Head and neck cancer, Intensive care unit, Ketamine, Remifentanil, Pain control, Airway management, Ventilatory management.