Preemptive Analgesic Effect of Ketamine in Patients Undergoing Elective Cesarean Section

Fazel,; Zahra, Forghani; Fakharian, Esmaeil; Akbari, Hossein

doi:10.1097/ajp.0b013e3181bff86d

Cited by 46 publications

(54 citation statements)

References 30 publications

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“…According to inclusion criteria in our analysis, a total of five English studies 13,[17][18][19][20] matched the selection criteria finally (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…These study results of Nesek-Adam et al 20 were all no statistically significant. Lenzmeier et al 19 and Reza et al 13 assessed the postoperative pain scores of ketamine at a dosage of 0.50 mg/kg. Lenzmeier et al 19 reported that the postoperative pain score (p<0.05) at post-anaesthesia care unit (PACU) were lower in ketamine group than that in control group but no significant difference were found among the two groups for the postoperative pain intensity when the patients discharged from hospital.…”

Section: Postoperative Pain Scorementioning

confidence: 99%

“…The publication year of studies ranged from 2000 to 2012. The studies respectively come from Asian 13,18 , Europe 19,20 and America 17 . Total 266 patients (including 139 patients in ketamine group and 127 patients in control group) were included in this meta-analysis.…”

Section: Characteristic Of Included Studiesmentioning

confidence: 99%

“…The surgeries in the included studies were all abdominal surgery. Visual analog scale (VAS) and verbal rating scale (VRS) were used to evaluate pain in two included studies 17,20 , while the pain was accessed only based on the VAS in the other three studies 13,18,19 . The range dosage of ketamine was 0.15 -0.5 mg/kg.…”

Section: Characteristic Of Included Studiesmentioning

confidence: 99%

“…Subramaniam et al 12 reported that the addition of epidural ketamine 1 mg/kg to morphine 50 μg/kg improved analgesia after major upper abdominal surgery without increasing side effects. While another recent studies found that the preoperative administration of 0.5 mg/kg ketamine in patients undergoing cesarean section did not elicit a preemptive analgesic effect 13 . Moreover, Hala et al 14 reported that intranasal ketamine could enhance the postoperative analgesia after endoscopic nasal surgery, but the psychomimetic side effects of ketamine still occurred with intranasal administration.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Yang¹,

Zhang²,

Zhang³

et al. 2014

Acta Cir. Bras.

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“…According to inclusion criteria in our analysis, a total of five English studies 13,[17][18][19][20] matched the selection criteria finally (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

Section: Postoperative Pain Scorementioning

confidence: 99%

Section: Characteristic Of Included Studiesmentioning

confidence: 99%

Section: Characteristic Of Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Yang¹,

Zhang²,

Zhang³

et al. 2014

Acta Cir. Bras.

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Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Wang

Deng

et al. 2023

JAMA Netw Open

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ImportanceEpidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction.ObjectiveTo investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia.Design, Setting, and ParticipantsThis multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022.InterventionPatients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision.Main Outcomes and MeasuresThe coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth.ResultsA total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P &lt; .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P &lt; .001).Conclusions and RelevanceFor women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia.Trial RegistrationClinicalTrials.gov Identifier: NCT04548973

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Perioperative intravenous ketamine for acute postoperative pain in adults

Brinck

Tiippana

Heesen

et al. 2018

CDSR

187

134

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Data collection and analysis Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest and during movement at 24 and 48 hours postoperatively. Secondary outcomes were time to first analgesic request, assessment of postoperative hyperalgesia, central nervous system (CNS) adverse effects, and postoperative nausea and vomiting. We assessed the evidence using GRADE and created a 'Summary of findings' table. Main results We included 130 studies with 8341 participants. Ketamine was given to 4588 participants and 3753 participants served as controls. Types of surgery included ear, nose or throat surgery, wisdom tooth extraction, thoracotomy, lumbar fusion surgery, microdiscectomy, hip joint replacement surgery, knee joint replacement surgery, anterior cruciate ligament repair, knee arthroscopy, mastectomy, haemorrhoidectomy, abdominal surgery, radical prostatectomy, thyroid surgery, elective caesarean section, and laparoscopic surgery. Racemic ketamine bolus doses were predominantly 0.25 mg to 1 mg, and infusions 2 to 5 µg/kg/minute; 10 studies used only S-ketamine and one only R-ketamine. Risk of bias was generally low or uncertain, except for study size; most had fewer than 50 participants per treatment arm, resulting in high heterogeneity, as expected, for most analyses. We did not stratify the main analysis by type of surgery or any other factor, such as dose or timing of ketamine administration, and used a non-stratified analysis. Perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine equivalents (95% CI 6 to 9; 19% from 42 mg consumed by participants given placebo, moderate-quality evidence; 65 studies, 4004 participants). Over 48 hours, opioid consumption was 13 mg lower (95% CI 10 to 15; 19% from 67 mg with placebo, moderate-quality evidence; 37 studies, 2449 participants). Perioperative intravenous ketamine reduced pain at rest at 24 hours by 5/100 mm on a visual analogue scale (95% CI 4 to 7; 19% lower from 26/100 mm with placebo, high-quality evidence; 82 studies, 5004 participants), and at 48 hours by 5/100 mm (95% CI 3 to 7; 22% lower from 23/100 mm, high-quality evidence; 49 studies, 2962 participants). Pain during movement was reduced at 24 hours (6/100 mm, 14% lower from 42/100 mm, moderate-quality evidence; 29 studies, 1806 participants), and 48 hours (6/100 mm, 16% lower from 37 mm, low-quality evidence; 23 studies, 1353 participants). Results for primary outcomes were consistent when analysed by pain at rest or on movement, operation type, and timing of administration, or sensitivity to study size and pain intensity. No analysis by dose was possible. There was no difference when nitrous oxide was used. We downgraded the quality of the evidence once if numbers of participants were large but small-study effects were present, or twice if numbers were small and small-study effects likel...

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Preemptive Analgesic Effect of Ketamine in Patients Undergoing Elective Cesarean Section

Cited by 46 publications

References 30 publications

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Perioperative intravenous ketamine for acute postoperative pain in adults

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