Postoperative Ketamine Administration Decreases Morphine Consumption in Major Abdominal Surgery: A Prospective, Randomized, Double-Blind, Controlled Study

Zakine, J.; Samarcq, David; Lorne, Emmanuel; Moubarak, Mona; Montravers, Philippe; Béloucif, Sadek; Dupont, Hervé

doi:10.1213/ane.0b013e3181732776

Cited by 140 publications

(78 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Whether the reduction of morphine-related adverse events, e.g., PONV, is due to the decreased morphine consumption after adding ketamine remains uncertain. Nevertheless, this metaanalysis lends support for the relationship between reduced opioid leading to reduced PONV 41,45 but without sufficient reports from the included studies regarding other opioid-related adverse events.…”

Section: Relationship With Prior Reviewsmentioning

confidence: 81%

“…Supplementary 18,[20][21][22][25][26][27]29,30,32,34,36,40,41,44,45,50 cardiac or thoracic surgery (six trials), 19,23,35,37,38,53 orthopedic surgery (ten trials), 24,28,31,33,39,43,[47][48][49]51 and other surgery (three trials). 42,46,52 General anesthesia was used in 34 trials; one trial used PCA during and after a uterine artery embolization procedure, 29 and one used either general or regional anesthesia.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

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

Wang

Johnston

Kaushal

et al. 2015

Can J Anesth/J Can Anesth

104

View full text Add to dashboard Cite

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/

show abstract

Section: Relationship With Prior Reviewsmentioning

confidence: 81%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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

Wang

Johnston

Kaushal

et al. 2015

Can J Anesth/J Can Anesth

104

View full text Add to dashboard Cite

show abstract

“…22 Of the 70 studies meeting inclusion criteria, 64 were suitable for inclusion in the quantitative analysis, and the remaining six were added to the qualitative analysis. These six studies reported data which were not useable in the quantitative analysis, such as median and range (two), mean only (one), mean and range (one), graphical data and SEM (one), and number of events of non-opioid rescue analgesia (one) were initially analyzed quantitatively, an additional 17 studies [70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] were used to corroborate the results within the quantitative analysis, and the remaining six studies [87][88][89][90][91][92] were added to the qualitative analysis. All 70 studies had either low or unclear risks of bias in all six categories of the Cochrane Collaboration's tool for assessing risk of bias (see Table 1).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of intravenous ketamine for postoperative analgesia

Laskowski

Stirling

McKay

et al. 2011

Can J Anesth/J Can Anesth

503

313

View full text Add to dashboard Cite

Purpose Perioperative intravenous ketamine may be a useful addition in pain management regimens. Previous systematic reviews have included all methods of ketamine administration, and heterogeneity between studies has been substantial. This study addresses this issue by narrowing the inclusion criteria, using a random effects model, and performing subgroup analysis to determine the specific types of patients, surgery, and clinical indications which may benefit from perioperative ketamine administration. Source We included published studies from 1966 to 2010 which were randomized, double-blinded, and placebocontrolled using intravenous ketamine (bolus or infusion) to decrease postoperative pain. Studies using any form of regional anesthesia were excluded. No limitation was placed on the ketamine dose, patient age, or language of publication. Principal findings Ninety-one comparisons in seventy studies involving 4,701 patients met the inclusion criteria (2,652 in ketamine groups and 2,049 in placebo groups). Forty-seven of these studies were appropriate for evaluation in the core meta-analysis, and the remaining 23 studies were used to corroborate the results. A reduction in total opioid consumption and an increase in the time to first analgesic were observed across all studies (P \ 0.001). The greatest efficacy was found for thoracic, upper abdominal, and major orthopedic surgical subgroups. Despite using less opioid, 25 out of 32 treatment groups (78%) experienced less pain than the placebo groups at some point postoperatively when ketamine was efficacious. This finding implies an improved quality of pain control in addition to decreased opioid consumption. Hallucinations and nightmares were more common with ketamine but sedation was not. When ketamine was efficacious for pain, postoperative nausea and vomiting was less frequent in the ketamine group. The dose-dependent role of ketamine analgesia could not be determined. Conclusion Intravenous ketamine is an effective adjunct for postoperative analgesia. Particular benefit was observed in painful procedures, including upper abdominal, thoracic, and major orthopedic surgeries. The analgesic effect of ketamine was independent of the type of intraoperative opioid administered, timing of ketamine administration, and ketamine dose. RésuméObjectif La ke´tamine intraveineuse pe´riope´ratoire peut constituer un ajout utile a`l'arsenal the´rapeutique de prise en charge de la douleur. Les revues me´thodiques pre´ce´dentes ont examine´toutes les me´thodes d'administration de la ke´tamine, et l'he´te´roge´ne´ite´entre les e´tudes est conside´rable. Cette e´tude aborde la question en limitant les crite`res d'inclusion, en utilisant un mode`le a`effets ale´atoires et en re´alisant une analyse de sous-groupe afin de de´terminer les types spe´cifiques de patients et de chirurgie ainsi que les indications cliniques qui pourraient be´ne´ficier de l'administration pe´riope´ratoire de ke´tamine.

show abstract

“…Ketamine is also associated with opioid tolerance reversal, and no medication interactions have been reported with its use (29). Zakine et al (30) compared supplemental ketamine and found improved analgesia along with decreased morphine consumption and a lower incidence of nausea and other side effects when administered for 48 h postoperatively. Another study examined sub-anaesthetic ketamine administration and found that it was effective in reducing morphine requirements for 24 h after surgery along with reduced PONV and with AEs reported as mild or absent (31).…”

Section: Discussionmentioning

confidence: 99%

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Halaszynski

Dai

Huang

2018

Turk J Anaesth Reanim

View full text Add to dashboard Cite

Objective: Inferior and limited analgesic options/techniques during living donor hepatectomy surgery can result in pain and risks of morbidity, opioid-related adverse events (AEs), predisposition to the development of chronic pain and concerns of potential narcotic abuse. Traditional analgesia uses unimodal intravenous opioids that can cause significant side effects. Ketamine provides analgesia and may be opioid sparing, but use in living-donor hepatectomy has not been studied. Methods: Following human investigation committee approval and informed written consent, 47 liver donor patients over a 5-year period scheduled for surgery were categorized into one of three groups: 24 patients received no ketamine (Group 1), 9 received only intraoperative ketamine (Group 2) and 14 patients received intraoperative plus postoperative ketamine (Group 3). Subjects had access to opioid patient-controlled analgesia (PCA). Chart reviews (including operating room and intensive care unit) were collected and analysed for morphine consumption, pain-intensity scores, opioid-sparing effects, AEs of analgesics and for evidence of ketamine side effects on donor hepatectomy patients. Results: There were no differences in patient demographics. Living donor hepatectomy patients receiving intraoperative ketamine that was continued postoperatively consumed fewer morphine-equivalents and had lower median pain scores than subjects from the other two groups. Ileus occurred in those not receiving ketamine, pruritus was lowest in Group 3, and there was no evidence or reports of ketamine-associated AEs. Conclusion: Perioperative ketamine for donor hepatectomy patients could safely provide improved analgesia and be opioid sparing when compared to PCA opioids alone, and there is no evidence of ketamine-related AEs at the dose and delivery methods described here during partial liver donation surgery. Keywords: Living-donor liver transplantation, ketamine, perioperative analgesia Amaç: Canlı donörlü hepatektomi ameliyatı sırasında uygulanan inferior ve sınırlı analjezi seçenekleri/teknikleri ağrıya ve morbidite riskine, opioide bağlı yan etkilere, kronik ağrı gelişimi eğilimine ve potansiyel narkotik bağımlılığına neden olabilirler. Geleneksel analjezi uygulamasında, önemli yan etkilere neden olabilen unimodal intravenöz opioidler kullanılmaktadır. Ketamin analjezi sağlar ve opioid tüketimini azaltabilir. Ancak canlı donörlü hepatektomide kullanımı hakkında henüz çalışma yapılmamıştır. Yöntemler: İnsan araştırmaları etik kurulu onayı ve yazılı bilgilendirilmiş hasta onam formu alındıktan sonra, 5 yıllık bir süreçte ameliyat olması planlanan 47 canlı donör hastası 3 gruba ayrıldı. 24 hastaya hiç ketamin verilmedi (Grup 1); 9 hastaya sadece intraoperatif ketamin verildi (Grup 2); ve 14 hastaya intraoperatif ve postoperatif ketamine uygulandı (Grup 3). Denekler hasta kontrollü opioid analjezisi kullandılar. Hastaların tıbbi kayıtları toplandı (ameliyathane ve yoğun bakım ünitesinden) ve morfin kullanımı, ağrı-yoğunluk skorları, opioid tüketiminin azaltıc...

show abstract

Postoperative Ketamine Administration Decreases Morphine Consumption in Major Abdominal Surgery: A Prospective, Randomized, Double-Blind, Controlled Study

Abstract: Low-dose ketamine improved postoperative analgesia with a significant decrease of morphine consumption when its administration was continued for 48 h postoperatively, with a lower incidence of nausea and with no side effects of ketamine.

Cited by 140 publications

References 34 publications

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

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

A systematic review of intravenous ketamine for postoperative analgesia

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation

Contact Info

Product

Resources

About