Ketamine and postoperative pain – a quantitative systematic review of randomised trials
Top Cited Papers
- 1 January 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pain
- Vol. 113 (1), 61-70
- https://doi.org/10.1016/j.pain.2004.09.036
Abstract
Ketamine, an N-methyl-D-aspartate receptor antagonist, is known to be analgesic and to induce psychomimetic effects. Benefits and risks of ketamine for the control of postoperative pain are not well understood. We systematically searched for randomised comparisons of ketamine with inactive controls in surgical patients, reporting on pain outcomes, opioid sparing, and adverse effects. Data were combined using a fixed effect model. Fifty-three trials (2839 patients) from 25 countries reported on a large variety of different ketamine regimens and surgical settings. Sixteen studies tested prophylactic intravenous ketamine (median dose 0.4 mg/kg, range (0.1-1.6)) in 850 adults. Weighted mean difference (WMD) for postoperative pain intensity (0-10 cm visual analogue scale) was -0.89 cm at 6 h, -0.42 at 12 h, -0.35 at 24 h and -0.27 at 48 h. Cumulative morphine consumption at 24 h was significantly decreased with ketamine (WMD -15.7 mg). There was no difference in morphine-related adverse effects. The other 37 trials tested in adults or children, prophylactic or therapeutic ketamine orally, intramuscularly, subcutaneously, intra-articulary, caudally, epidurally, transdermally, peripherally or added to a PCA device; meta-analyses were deemed inappropriate. The highest risk of hallucinations was in awake or sedated patients receiving ketamine without benzodiazepine; compared with controls, the odds ratio (OR) was 2.32 (95%CI, 1.09-4.92), number-needed-to-harm (NNH) 21. In patients undergoing general anaesthesia, the incidence of hallucinations was low and independent of benzodiazepine premedication; OR 1.49 (95%CI 0.18-12.6), NNH 286. Despite many published randomised trials, the role of ketamine, as a component of perioperative analgesia, remains unclear.Keywords
This publication has 62 references indexed in Scilit:
- Postoperative pain management with intravenous patient-controlled morphine: comparison of the effect of adding magnesium or ketamineEuropean Journal of Anaesthesiology, 2003
- No pain, no gain: clinical excellence and scientific rigour – lessons learned from IA morphinePain, 2002
- Supplementing Desflurane-Remifentanil Anesthesia with Small-Dose Ketamine Reduces Perioperative Opioid Analgesic RequirementsAnesthesia & Analgesia, 2002
- Preincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomySurgical Endoscopy, 2001
- Reporting of Adverse Effects in Clinical Trials Should Be Improved: Lessons from Acute Postoperative PainJournal of Pain and Symptom Management, 1999
- Propofol Versus Propofol-Ketamine Sedation for Retrobulbar Nerve BlockAnesthesia & Analgesia, 1999
- Postoperative Analgesic Requirement After Cesarean SectionAnesthesia & Analgesia, 1997
- Preemptive Ketamine Decreases Postoperative Narcotic Requirements in Patients Undergoing Abdominal SurgeryAnesthesia & Analgesia, 1997
- Comparison of morphine and morphine with ketamine for postoperative analgesiaCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1996
- Ketamine Infusion for Postoperative Analgesia in AsthmaticsAnesthesia & Analgesia, 1993