Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials

Abstract

Purpose To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery.Source We systematically searched six databases up to June 2, 2015 for randomized controlled trials (RCTs) comparing ketamine plus morphine/hydromorphone PCA vs morphine/hydromorphone PCA for postoperative pain in adults. Principal findings Thirty-six RCTs including 2,502 patients proved eligible, and 22 of these were at low risk of bias. The addition of ketamine to morphine/

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

“…Low dose ketamine infusions can be used on a general floor and do not require additional nursing interventions or personnel (Jouguelet-Lacoste et al 2015). When compared with opioids alone, ketamine has been shown in meta-analysis and systematic reviews to demonstrate improved pain control and reduced PONV without increases in adverse side effects (Jouguelet-Lacoste et al 2015; Wang et al 2016; Ding et al 2014). Ketamine should be considered as an adjunct for those experiencing pain not adequately controlled by other schedule non-opioid medications and is particularly useful in patients on long-term opioid medication.…”

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1—from the preoperative period to PACU

“…Perioperative inhibition of N -methyl- d -aspartate (NMDA) receptors with clinically available NMDA antagonists such as ketamine may be associated with improved perioperative pain and decreased opioid use (Wang et al 2016; Ding et al 2014; Dahmani et al 2011; Bell et al 2006). Perioperative ketamine, including boluses as well as intraoperative and postoperative low-dose infusions for up to 48 h, has been shown to result in significant reductions in pain, opioid consumption, and PONV with no significant side effect profile (Zakine et al 2008; Laskowski et al 2011; Sami Mebazaa et al 2008).…”

Low-Dose Ketamine for Acute Pain Management

“…23 In contrast, studies with a much smaller sample size where low-dose ketamine was added to opioids postoperatively show only a small decrease in pain intensity but substantial reduction in opioids and opioid-related adverse effects such as postoperative nausea and vomiting. 26,27 Use of low-dose ketamine may well be a valuable strategy to help with both aspects of the current opioid crisis. The authors themselves point out that ketamine may have considerable value in reducing perioperative opioid doses, and use of less opioid may reduce long-term opioid use after surgery.…”