Opioid-sparing by low-dose ketamine for endometriosis surgery. A single-center, prospective, randomized, trial.

Endometriosis affects 10% of women of childbearing age and 25-50% of infertile women worldwide. Although most patients with endometriosis are completely asymptomatic, there is still a significant proportion of patients, whose quality of life is impaired by the disease, resulting in chronic pelvic pain. However, there is a poor correlation between objective findings of significant endometriosis and pain severity. Opioids typically form part of a postoperative analgesic regimen. However, opioid tolerance, adverse effects, contraindications, or a combination of these factors may limit their use. As part of the multimodal regime, ketamine may play a critical role for patients undergoing surgery when postoperative pain is expected to be severe. It is most commonly used for acute pain management in settings involving trauma, the exacerbation of chronic painful conditions, and postsurgical pain, particularly in opioid-tolerant patients, generally at subanesthetic doses. Notably, in therapy-refractory pharmacological situations, surgical treatment of endometriosis with intraoperative low-dose ketamine could be helpful and may constitute an effective strategy for limiting disease recurrence. However, it is important to evaluate the significance of ketamine in endometriosis surgery for preventing chronic pain syndrome, which in turn would result in an improvement in the quality of life of patients with endometriosis.Clinical trial registration: www.clinicaltrials.gov identifier is NCT06951802.Endometriosis is a condition that affects about 10% of women who can have children and up to half of women who have trouble getting pregnant. Many women with endometriosis do not have symptoms, but a good number suffer from chronic pelvic pain that really lowers their quality of life. Interestingly, how bad the pain feels do not always match what doctors see during examinations. After surgery, opioids are commonly used to manage pain. However, opioids are not always the best choice because some people develop tolerance, have side effects, or cannot take them due to other health issues. That is where the medicament “ketamine” can be useful as part of a combined pain relief plan, especially for patients expected to have severe pain after surgery. Ketamine is often given in low doses to help with acute pain, particularly in patients who have become tolerant to opioids. In cases where regular drugs do not work well, ketamine given during surgery for endometriosis might help not only with pain relief but also help prevent in reducing long-term pain syndromes, improving the overall quality of life for these patients. So, while ketamine is not a magic fix, it might be an important part of managing severe pain in endometriosis surgery and helping women feel better in the long run.