Perioperative intravenous ketamine for acute postoperative pain in adults

Brinck, Elina C. V.; Tiippana, Elina; Bell, Rae Frances; Straube, Sebastian; Kontinen, Vesa K.

doi:10.1002/14651858.cd012033

Cited by 74 publications

(124 citation statements)

References 32 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…The most recent Cochrane review of perioperative ketamine use for acute postoperative pain in over 130 predominantly small trials, mostly containing fewer than 50 patients, found that its use was associated with decreased postoperative morphine consumption at 24 and 48 h, along with decreased pain intensity. Although the benefits are thought to be somewhat offset by dose‐dependent adverse effects, including hypersalivation, nausea and vomiting, and psychotomimetic effects such as vivid dreams, blurred vision, hallucinations, nightmares and delirium, there was a non‐clinically significant reduction in nausea and vomiting and little difference compared with controls in terms of central nervous system side‐effects. Ketamine is also thought to reduce the likelihood of transition to PPSP.…”

Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

Acute postoperative pain management

Small

Laycock

2020

British Journal of Surgery

204

100

View full text Add to dashboard Cite

Background Acute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management. Methods A narrative review of postoperative pain strategies was undertaken. Searches of the Cochrane Library, PubMed and Google Scholar databases were performed using the terms postoperative care, psychological factor, pain management, acute pain service, analgesia, acute pain and pain assessment. Results Information on service provision, preoperative planning, pain assessment, and pharmacological and non‐pharmacological strategies relevant to acute postoperative pain management in adults is presented, with a focus on enhanced recovery after surgery pathways. Conclusion Adequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.

show abstract

Section: Pharmacological Management Of Postoperative Painmentioning

confidence: 99%

Acute postoperative pain management

Small

Laycock

2020

British Journal of Surgery

204

100

View full text Add to dashboard Cite

show abstract

“…The efficacy and safety of the administration of ketamine for postoperative pain relief has been examined for decades, but the findings are still contradictory and inconclusive 9 10 26–28. A previous Cochrane review published in 2006, which included 37 trials involving different routes of administration (ie, intravenous, intramuscular and epidural),10 suggested that ketamine in subanaesthetic dose was effective in reducing the demand of morphine during the first 24 hours after surgery with no major complications.…”

Section: Discussionmentioning

confidence: 99%

“…Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist that has been widely used as an anaesthetic drug for the management of postoperative pain 6–8. Several reviews and meta-analyses have been carried out focusing on its benefit and risk profiles 9 10. However, with different administration routes of ketamine and types of surgery, the overall findings appear contradictory.…”

Section: Introductionmentioning

confidence: 99%

“…However, with different administration routes of ketamine and types of surgery, the overall findings appear contradictory. More recently, a Cochrane review conducted by Brinck and colleagues showed that the perioperative intravenous ketamine might reduce postoperative analgesic consumption and pain intensity; this finding has a significant meaning in guiding clinical practice 9. Nevertheless, to our best knowledge, few studies have investigated the beneficial effect of ketamine on patients after total knee or hip arthroplasty, who are likely to experience severe postoperative pain and suffer from impeded rehabilitation and prolonged hospitalisation 1–3.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

Wang

Zeng

et al. 2019

BMJ Open

View full text Add to dashboard Cite

ObjectiveTo examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE and Cochrane Library from inception to 22 May 2019.Eligibility criteria for selecting studiesRandomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty.Data extraction and synthesisData (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration’s recommended tool was used to determine the methodological quality of included studies.ResultsA total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0–8-hour (weighted mean difference (WMD) −1.21, 95% CI −1.45 to −0.98, p<0.001; three studies, 149 participants) but not during 8–24-hour postoperative periods, and effective for reduction of cumulative morphine consumption during both 0–24-hour (WMD −17.76, 95% CI −31.25 to −4.27, p=0.01; five studies, 366 participants) and 0–48-hour (WMD −21.79, 95% CI −25.46 to −18.11, p<0.001; four studies, 252 participants) postoperative periods, without increasing risks of gastrointestinal or psychotic adverse effects. The limited data available for intra-articular (WMD −0.49, 95% CI −0.70 to −0.29, p<0.001; two studies, 83 participants) and epidural (WMD −2.10, 95% CI −3.30 to −0.90, p<0.001; one study, 20 participants) ketamine pointed to a significant reduction in pain intensity during 8–24-hour postoperative period.ConclusionsIntravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.

show abstract

“…A Cochrane review of 130 randomized, double-blind, controlled trials of adults undergoing surgery under general anesthesia with perioperative IV ketamine administration found that its use likely reduces postoperative analgesia usage and pain intensity with consistent results across different operation types. 37 Within orthopaedics specifically, the efficacy of ketamine has been demonstrated as an adjunct for postoperative pain control with opioid-sparing effects in both total hip arthroplasty and total knee arthroplasty. 38,39 While ketamine use in the multiligament knee has not been described, Menigaux et al report reduced postoperative morphine requirements and improved mobilization following ACL repair with intraoperative ketamine use.…”

Section: Ketaminementioning

confidence: 99%

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

Fanelli

2019

J Knee Surg

View full text Add to dashboard Cite

The multiligament knee injury presents as a complex injury pattern that has substantial potential to cause long-term disability. Patients who sustain this injury pattern experience significant pain not only immediately following injury but also throughout the perioperative and postoperative period. Treating pain with major orthopaedic procedures is challenging but technical success of a surgical repair becomes trivial when pain is not effectively managed. This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery.

show abstract

Perioperative intravenous ketamine for acute postoperative pain in adults

Cited by 74 publications

References 32 publications

Acute postoperative pain management

Acute postoperative pain management

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

Contact Info

Product

Resources

About