Optimizing the Use of Ketamine to Reduce Chronic Postsurgical Pain

Exclusion Criteria

• •History of cognitive impairment or clinical signs of altered mental status (AMS) that may interfere with adherence to study procedures and/or participant safety. Clinical signs of AMS may include but are not limited to: confusion, amnesia, disorientation, fluctuating levels of alertness, etc.
• •Past ketamine or phencyclidine misuse or abuse
• •Schizophrenia or history of psychosis
• •History of post-traumatic stress disorder
• •Known sensitivity or allergy to ketamine
• •Liver or renal insufficiency
• •History of uncontrolled hypertension, chest pain, cardiac arrhythmia, stroke, head trauma, intracranial mass or hemorrhage, glaucoma, porphyria, uncontrolled thyroid disease, or other contraindication to ketamine
• •Lamotrigine, alfentanil, physostigmine, or 4-aminopyridine use
• •Currently Pregnant
• •Body mass index (BMI) equal to or greater than 41
• •Non-English or non-Spanish speaker
• •Currently participating in another pain interventional trial
• •Unwilling to comply with all study procedures and be available for the duration of the study
• •Patient is American Society of Anesthesiologists (ASA) physical status 4, 5, or 6
• •Patient has started or undergone hormone therapy for gender transition into male.
• •Patient scheduled for any bilateral (or greater) flap reconstruction