Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective. Although low-dose ketamine has been shown to be generally beneficial in terms of pain control in a variety of major surgery, there is no consensus regarding the effectiveness of supplemental ketamine analgesic use exclusively in spine surgery. The objective of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess the efficacy and safety of perioperative low-dose ketamine for pain management and analgesic consumption in patients undergoing spine surgery. Methods. A comprehensive literature search was performed for relevant studies using PubMed, EMBASE, Web of Science, and Cochrane Library. Patients who received perioperative low-dose ketamine were compared to the control group in terms of postoperative pain intensity, opioid consumption, and adverse events. Patients were further categorized by ages and administration times for subgroup analysis. Results. A total of 30 RCTs comprising 1,865 patients undergoing elective spine surgery were included. Significantly lower pain intensity and less opioid consumption at 12 h, 24 h, and 48 h postoperatively and lower incidence of postoperative nausea and vomiting (PONV) were observed in the ketamine group (all P < 0.05 ). There was no significant difference of central nervous system (CNS) adverse events between groups. However, different efficacy of low-dose ketamine was detected when patients were categorized by ages and administration times. Conclusion. Perioperative low-dose ketamine demonstrated analgesic and morphine-sparing effect with no increased adverse events after spine surgery. However, this effect was not significant in pediatric patients. Only postoperative or intraoperative and postoperative administration could prolong the analgesic time up to 48 h postoperatively. Further studies should focus on the optimal protocol of ketamine administration and its effect on old age participants.

Respuesta hemodinámica a dosis subanestésicas de ketamina en dolor posoperatorio: revisión sistemática

“…This is consistent with its analgesic effect broadly described in the literature. (3,5,17) Likewise, a reduction in the use of opioids was identified, which could be accounted for by the multimodal strategy in pain control; these findings were already reported in previous studies. (4,(18)(19)(20) While LDKI has a clear value in the use of opioids and the prevention of opioid-induced tolerance/hyperalgesia, there is very little information about its potential cardiovascular effects at doses lower than the bolus, or those used during the perioperative period.…”

“…(1,2) The use of low-dose ketamine infusion (LDKI) has increased in postoperative pain models associated with severe pain. (3,4) Ketamine is associated with dosedependent adverse effects -such as psychomimetic -which according to the various studies published so far apparently do not impact the recovery. (4,5) The cardiovascular effects are usually less frequent, but may be a contraindication for high risk patients.…”

Intravenous ibuprofen versus ketorolac for perioperative pain control in open abdominal hysterectomy: a randomized controlled trial

“…In this study, we used ibuprofen at a dose of 800 mg since it is the most used in previous reports [24]; furthermore, it is the maximum allowed single dose for the drug. Since there are no data regarding the equipotent dosing of intravenous formulation of NSAIDs; we also used the maximum allowed dose for ketorolac [25].…”

Unilateral biportal endoscopic lumbar interbody fusion enhanced the recovery of patients with the lumbar degenerative disease compared with the conventional posterior procedures: A systematic review and meta-analysis

“…Conventional posterior procedures include minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) through microscopic tubular technique and open posterior lumbar interbody fusion (PLIF) ( 4 ). However, lumbar interbody fusion has been rated as one of the most painful procedures ( 5 , 6 ). The main disadvantage of the conventional MI-TLIF or PLIF is the extensive paraspinal iatrogenic damage caused by dissection and retraction, which would induce the risk of chronic pain and delay patients' post-operative recovery and mobilization, placing a substantial economic burden on the public healthcare systems ( 7 , 8 ).…”