Disclosures: David K. Jacobs, MD: Interventional Orthopedics Foundation: Other Financial or Material Support, Conference stipend recipient

Case Description: Particulated juvenile articular cartilage allograft transplantation (PJACAT) is a rare procedure for treating osteochondral talar lesions. Central pain syndrome (CPS) develops after CNS insult or after central sensitization of a peripheral nerve injury or an inflammatory process. We present a case of CPS after PJACAT that was treated with ketamine after failing multiple analgesics.

Setting: Acute care hospital

Patient: A 56-year-old male with a history of bilateral osteochondral talar lesions status-post bilateral debridement and PJACAT presented to the pain clinic with left ankle pain. His pain was not controlled with amitriptyline, methadone, gabapentin, pregabalin, clonidine, duloxetine, diazepam, tizanidine, or lidocaine infusions. He also failed trials of physical therapy, immobilization, and acupuncture. The pain was described as pins and needles and was associated with posterior calf tightness. Physical exam revealed purple discoloration of the left foot, toes, and ankle, decreased capillary refill, and mild edema.

Assessment/Results: Vascular and cardiac workup was negative. A lumbar sympathetic block led to only 15% reported pain improvement. The patient received ketamine intravenous infusions of 20-80 mg, over four years, with greater than 50% improvement lasting greater than three weeks, on average, after each infusion. The patient’s analgesic regimen was consolidated.

Discussion: Ketamine’s effectiveness has been equivocal in treating pain syndromes. Few studies have examined its long-term use and only one study examined its use in CPS, in which a seven-day ketamine course led to a decrease in the patient’s analgesic regimen. This case report supports the previous literature suggesting that repeat ketamine infusions are needed to sustain analgesia.

Conclusion: Though promising, more studies are needed to evaluate the effectiveness and side effects of ketamine’s long-term use in treating chronic pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/central-pain-syndrome-after-particulated-juvenile-articular-cartilage-allograft-transplantation-effectively-treated-with-ketamine/