Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis

Abstract

Background: The pain control effect of ketamine versus control in women during cesarean operation is not well determined. Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. Study Design: We used meta-analysis to address this concern. Setting: Meta-analysis-based study. Methods: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limitations: Limited patients were included with moderate strength. Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis

Reduced Pain and Improved Function Following Short-Term Use of Noninvasive BioWave High Frequency Peripheral Nerve Stimulation for Pain Management

“…Chronic pain can often develop after surgical procedures making patients more reluctant to undergo another invasive procedure. Having a treatment option that does not require an operation could help patient adherence and possibly lead to treating chronic pain earlier in its disease process [20,21].…”

Routine Prophylactic Esketamine for the Prevention of Maternal Pain During Cesarean Delivery

“…The authors report no clinically significant difference in numeric rating scale (NRS) pain scores at any of the 8 prespecified time points, which ranged from immediately through 12 hours (median difference in NRS scores, 0; 95% CI, 0-0). In contrast, median (IQR) sedation scores were significantly increased during the operative period (2 in the placebo group vs vs 4 [3][4] in the esketamine group), suggesting that mothers were "light asleep but responding to touch or pain." Placental transfer of esketamine was evident in the small subsample (n = 13) of neonatal blood samples, yet neonatal outcomes (Apgar scores and acid-base status) were similar between the groups.…”

“…There are few studies with which to compare these findings. A meta-analysis of 20 RCTs (1737 patients) assessing the more commonly used racemic ketamine during cesarean delivery reported decreased postoperative pain and analgesia use, although the effect on intraoperative pain was not reported. Studies investigating the use of esketamine are even scarcer, with only 4 RCTs (n = 56-210) examining the role of systemic esketamine for cesarean pain but with substantially different study designs, primary outcomes, and esketamine doses .…”

The analgesic efficacy of intravenous dexamethasone for post-caesarean pain

“…Multimodal analgesia techniques, including NSAIDs, acetaminophen and systemic and neuraxial opioids have been employed to control postcaesarean pain effectively 5 . Given the adverse effects of opioids and the potential for continued opioid use, there has been keen interest in identifying effective co-analgesics like ketamine, gabapentin and glucocorticoids 6–8 …”

“…5 Given the adverse effects of opioids and the potential for continued opioid use, there has been keen interest in identifying effective co-analgesics like ketamine, gabapentin and glucocorticoids. [6][7][8] Dexamethasone, a synthetic glucocorticoid, is frequently recommended in the perioperative period to prevent and treat postoperative nausea and vomiting (PONV). 9 Apart from PONV, its analgesic potential has also been evaluated in the perioperative period.…”