“The surest way to reduce the risk of opioids, including side effects, is to not need them in the first place.”

Surgeries, such as total knee replacement (TKA), can change patient lives: restoring mobility, relieving chronic pain, and unlocking life experiences previously limited by their condition.

In online discussions among patients considering TKA, one concern surfaces again and again: pain and recovery expectations. Patients who have undergone the surgery are often strong advocates, pointing out that the benefits are well worth the pain and recovery time.

One such user captured that ethos by commenting: “DO IT!!!! […] it was game changer! […] enjoy a new life! I love my new knees – feel amazing and am pretty active.”

Improving pain during recovery post-surgery will benefit not only the patients already committed to undergoing surgery, but also sideliners delaying or not seeking treatment due to concerns that pain cannot be treated adequately, or without the additional risk and side effects of strong doses of opioids.

Today, for many patients, surgery is also their first encounter with opioids. That introduction can lead to unintended consequences. While improved opioid stewardship continues to lower the risk, the surest way to reduce the risk of opioids, including side effects, is to not need them in the first place.

Oral ketamine as a good alternative for acute pain

Ketamine has been shown to significantly reduce the need for opioids in the postoperative period, making it a valuable tool in efforts to address the opioid epidemic. Unlike opioids, ketamine targets the NMDA receptor pathway, thereby broadening its effect on pain modulation and helping to prevent central sensitization.

Currently, treatment options for acute pain, whether following surgery or traumatic injury, are dominated by opioids. This leaves patients and clinicians with limited safe alternatives. Oral ketamine has the potential to fill this gap, offering broader applicability in acute pain management while reducing opioid exposure.

The challenge lies not in ketamine’s efficacy, but in its delivery. IV administration is effective in hospitals but impractical for the weeks-long recovery at home after surgeries such as total knee replacement. Intranasal esketamine, meanwhile, is limited to certified treatment centers and was not developed for post-surgical pain.

While the focus of the opioid crisis often centers on chronic pain, acute pain remains one of the most common pathways to first-time opioid exposure. What patients need is a solution that fits seamlessly into at-home recovery. Oral ketamine offers that possibility: an opioid-sparing alternative that may not eliminate opioid use in every case, but can shorten the duration and reduce the dosage required. Even in the case of partial substitution. that represents a substantial step in reducing risk and improving overall recovery outcomes.

Vitalis’ vision to make an impact by making oral ketamine a reality

At Vitalis, we want to help prevent opioid dependency before it starts. With a viable option in oral ketamine, Vitalis and surgeons can offer a first-line post-surgical pain option, alongside NSAIDs and non-drug therapies, that will:

• Reduce opioid exposure after major procedures like TKA
• Improve patient safety and quality of life
• Support faster, more comfortable recoveries

Improving options in surgical pain management will improve the recovery of many existing patients with lower risks and potentially help convince those who need surgery but have been too afraid to make the leap.

Reference List

1. American College of Rheumatology. Joint Replacement Surgery – Patient Information. American College of Rheumatology; 2025. Available at: https://rheumatology.org/patients/joint-replacement-surgery

2. Namba RS, Paxton EW, Inacio MCS. Opioid Prescribing and Risk of Persistent Use Following Total Knee Arthroplasty. Journal of Arthroplasty. 2018;33(1):107–112.e1. doi:10.1016/j.arth.2017.08.050

3. Luby AO, Delgado MK, Brat GA, et al. Trends in Opioid Prescribing and New Persistent Opioid Use After Surgery in the United States. Annals of Surgery. 2025;281(3):347–352. doi:10.1097/SLA.0000000000006461

4. Zhou L, Gao X, Li Y, et al. Perioperative Low-Dose Ketamine Demonstrates Analgesic and Morphine-Sparing Effects After Spine Surgery: A Meta-Analysis of Randomized Controlled Trials. Journal of Spine Surgery. 2022;8(4):5131–5141. doi:10.21037/jss-21-117