Ketamine and postoperative pain – a quantitative systematic review of randomised trials

@article{Elia2005KetamineAP,
  title={Ketamine and postoperative pain – a quantitative systematic review of randomised trials},
  author={Nadia Elia and Martin R. Tram{\`e}r},
  journal={Pain},
  year={2005},
  volume={113},
  pages={61-70}
}
Benefit and harm of adding ketamine to an opioid in a patient-controlled analgesia device for the control of postoperative pain: systematic review and meta-analyses of randomized controlled trials with trial sequential analyses
TLDR
Trial sequential analyses confirmed the significant benefit of ketamine on pain intensity, cumulative morphine consumption, and postoperative nausea and vomiting and its inability to double the risk of hallucination.
Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review
TLDR
In a number of limited situations, ketamine has shown some efficacy in controlling postoperative pain and decreasing opioid consumption, but these effects are dose-dependent.
Effect of a low‐dose ketamine regimen on pain, mood, cognitive function and memory after major gynaecological surgery: a randomized, double‐blind, placebo‐controlled trial
TLDR
Ketamine, in combination with morphine and ketoprofen, did not improve postoperative pain scales and did not reduce morphine consumption and the incidence of morphine‐related adverse effects, suggesting that a low dose of ketamine should not be used for routine care.
Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials.
TLDR
A review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy.
Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials
TLDR
Adding ketamine to morphine/hydromorphone PCA provides a small improvement in postoperative analgesia while reducing opioid requirements and reduces postoperative nausea and vomiting; however, adverse events were probably underreported.
Perioperative ketamine for acute postoperative pain.
TLDR
Ketamine in subanaesthetic dose (that is a dose which is below that required to produce anaesthesia) is effective in reducing morphine requirements in the first 24 hours after surgery.
Effect of small dose ketamine on morphine requirement after intestinal surgery: A randomized controlled trial
TLDR
Ketamine may be a promising drug in low doses that can limit and even prevent worsened inflammation in abdominal surgery and resulted in decreased postoperative opioid use, decreased pain rating, earlier retains of bowel motility, and decreased incidence of side effects.
Impact of Intraoperative Ketamine on Postoperative Analgesic Requirement Following Bariatric Surgery: a Meta-analysis of Randomized Controlled Trials
TLDR
Improvements in pain outcomes immediately after surgery through perioperative intravenous ketamine administration despite the absence of analgesic benefit in the late postoperative period and a positive impact on postoperative nausea/vomiting are demonstrated.
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References

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Ketamine in Chronic Pain Management: An Evidence-Based Review
TLDR
The evidence for efficacy of ketamine for treatment of chronic pain is moderate to weak, however, in situations where standard analgesic options have failed ketamine is a reasonable “third line” option.
Adding Ketamine to Morphine for Patient-Controlled Analgesia After Major Abdominal Surgery: A Double-Blinded, Randomized Controlled Trial
TLDR
It is concluded that small-dose ketamine combined with PCA morphine provides no benefit to patients undergoing major abdominal surgery.
A Single Small Dose of Postoperative Ketamine Provides Rapid and Sustained Improvement in Morphine Analgesia in the Presence of Morphine-Resistant Pain
TLDR
The effects of postoperative coadministration of small doses of ketamine and morphine on pain intensity, Spo2, and subjectively rated variables in surgical patients who underwent standardized general anesthesia and complained of pain despite >0.1 mg/kg of IV morphine administration within 30 min are evaluated.
[Lack of pre-emptive analgesic effect of low-dose ketamine in postoperative patients. A prospective, randomised double-blind study].
TLDR
It is concluded that under the study conditions used, low dose ketamine, contrary to previously reported results, does not provide a clinically relevant pre-emptive analgesic effect in postoperative patients.
Perioperative Small-Dose S(+)-Ketamine Has No Incremental Beneficial Effects on Postoperative Pain When Standard-Practice Opioid Infusions Are Used
TLDR
In this study, S(+)-ketamine did not contribute to postoperative pain reduction, possibly because of the clinically routine perioperative opioid analgesia.
Adding Ketamine in a Multimodal Patient-Controlled Epidural Regimen Reduces Postoperative Pain and Analgesic Consumption
TLDR
It is concluded that adding ketamine 0.4 mg/mL in a multimodal PCEA regimen provides better postoperative pain relief and decreases consumption of analgesics.
Sensory Changes and Pain After Abdominal Hysterectomy: A Comparison of Anesthetic Supplementation with Fentanyl Versus Magnesium or Ketamine
TLDR
Generalized central sensory inhibition, differently affected by the drugs, predominated after surgery, and all adjuvants suppressed spinal sensitization after surgery.
Postoperative pain management with intravenous patient‐controlled morphine: comparison of the effect of adding magnesium or ketamine
TLDR
In the immediate postoperative period, the addition of magnesium or ketamine to morphine for intravenous patient‐controlled analgesia led to a significantly lower consumption of morphine.
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