The Effect of Low-Dose Intravenous Ketamine on Postoperative Pain Following Cesarean Section with Spinal Anesthesia: A Randomized Clinical Trial

Rahmanian, Mojgan; Leysi, Mehri; Hemmati, Ali Akbar; Mirmohammadkhani, Majid

doi:10.5001/omj.2015.03

Cited by 33 publications

(32 citation statements)

References 14 publications

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“…ketamine after delivery of the fetus reduced pain and rescue analgesics in the first 12 h after caesarean section [26]. In the latter study, no basic analgesia or additional baseline analgesia was given [26]. A meta-analysis on the i.v.…”

Section: Systemic Non-opioid and Opioid Analgesicsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Systemic Non-opioid and Opioid Analgesicsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…Ketamine appears to reduce analgesic requirement in the setting of acute pain. For example, in 160 patients undergoing cesarean section, a single postoperative intravenous ketamine bolus (0.25 mg/kg) was shown to reduce the severity of postoperative pain and decrease analgesic requirements [60]. As a result, ketamine can prevent opioid tolerance [61] and may reduce the rate of opioidinduced hyperalgesia following surgery [62], while also mitigating adverse effects linked to opiates such as respiratory suppression, oversedation, and hypotension [63].…”

Section: Ketamine and Pain Syndromesmentioning

confidence: 99%

A Review of Nonanesthetic Uses of Ketamine

Pribish

Wood

Kalava

2020

Anesthesiology Research and Practice

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Ketamine, a nonselective NMDA receptor antagonist, is used widely in medicine as an anesthetic agent. However, ketamine’s mechanisms of action lead to widespread physiological effects, some of which are now coming to the forefront of research for the treatment of diverse medical disorders. This paper aims at reviewing recent data on key nonanesthetic uses of ketamine in the current literature. MEDLINE, CINAHL, and Google Scholar databases were queried to find articles related to ketamine in the treatment of depression, pain syndromes including acute pain, chronic pain, and headache, neurologic applications including neuroprotection and seizures, and alcohol and substance use disorders. It can be concluded that ketamine has a potential role in the treatment of all of these conditions. However, research in this area is still in its early stages, and larger studies are required to evaluate ketamine’s efficacy for nonanesthetic purposes in the general population.

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“…First, a sensitivity analysis was used to detect the studies that could be the main contributors of heterogeneity. Consequently, the studies by Rahmanian et al (24) and Xu et al (28) were deemed for exclusion (Fig. 9).…”

Section: Heterogeneity Test and Publication Bias Testmentioning

confidence: 99%

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

Wang

Zhou

et al. 2020

Pain Phys

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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

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The Effect of Low-Dose Intravenous Ketamine on Postoperative Pain Following Cesarean Section with Spinal Anesthesia: A Randomized Clinical Trial

Cited by 33 publications

References 14 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

A Review of Nonanesthetic Uses of Ketamine

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

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