An Austin Health led international trial that hopes to be a game-changer in the prevention of post-surgical pain has recruited its first patient.
The Reduction of Chronic post-surgical pain with Ketamine (ROCKet) trial is the world's first large-scale trial into post-surgical pain prevention.
Austin Health and The University of Melbourne received $4.8 million in NHMRC funding to run the trial - the biggest grant allocated for 2017. Just under 5000 patients who are undergoing major surgery will be recruited over the next five years to test whether ketamine given prior to and following surgery reduces the incidence of chronic post-surgical pain.
Principal Investigator Philip Peyton, who is Austin Health's Director of anaesthesia research, said the trial's scale had captured the attention of the pain research community. Prof Peyton said several small trials of ketamine have had mixed results and it was accepted that a large definitive trial was needed.
Prof Peyton said chronic pain after surgery is a widespread problem, especially after breast cancer, abdominal and thoracic surgeries and knee and hip operations. A large Australasian study found 12 per cent of patients still suffered pain 12 months following major surgery, with a third rating their pain as severe.
"This not only has a significant impact on quality of life but also a substantial economic impact,'' Prof Peyton said.
Those in the control group will receive standard anaesthesia and post-operative pain relief while the other half will also receive ketamine during surgery and for up to 72 hours after their procedure. They will be tracked for one year after surgery.
Prof Peyton said ketamine targets receptors in the pain pathways of the spinal cord which are thought to be responsible for the progression of acute pain to chronic pain.
"We think it's a drug that may be able to cut that progression," Prof Peyton said.
"This trial is an exercise in prevention. We are not trying to treat chronic pain once it is established - that is really difficult and we think an ounce of prevention might be worth a pound of cure.
"If it is proven to be effective it will be a game-changer because there will be a really strong argument for making ketamine a routine part of anaesthetic care rather than something we reach for when we have a problem with difficult pain," Prof Peyton said.
The five-year trial will recruit about 1000 patients per year, initially in Australia followed by centres in New Zealand, Hong Kong and other parts of Asia. Prof Peyton said there had also been significant interest from North America and the UK.