Small-dose ketamine decreases postoperative morphine requirements

Kafali, Haluk; Aldemir, Betül Aslaner; Kaygusuz, Kenan; Gürsoy, Sinan; Kunt, Nur

doi:10.1017/s0265021504220282

Cited by 16 publications

(9 citation statements)

References 7 publications

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“…Of the three [35,44,50] that studied patients undergoing a major abdominal surgery, all reported a reduction of both opioid consumption and pain scores (of at least a few hours) when administrating ketamine. Two trials assessing lower abdominal surgeries [33,39] achieved similar results. Concerning upper abdominal surgeries, however, Edwards et al.…”

Section: Methodsmentioning

confidence: 77%

“…Four of these same six studies [39,40,42,44] found a reduction of opioid consumption with no accompanying decrease in VAS pain scores at 24 hours postoperative. Using a bolus dose of 0.15 mg/kg, Kafali et al.…”

Section: Methodsmentioning

confidence: 91%

“…Six studies [39–44] assessed the efficacy of a bolus dose of ketamine, representing a total of 441 patients, 280 of whom received ketamine. The doses assessed ranged from 0.15 mg/kg to 0.5 mg/kg.…”

Section: Methodsmentioning

confidence: 99%

“…Using a bolus dose of 0.15 mg/kg, Kafali et al. [39] reported an 18% decrease in morphine intake at 24 hours postoperative (ketamine = 44.2 mg vs placebo = 53.9 mg) with a change in VAS pain scores that was only significant at 30 minutes postoperative (ketamine = 3.00 vs placebo = 2.06 on a 10‐cm VAS) but not 24 hours postoperative (ketamine = 1.13 vs placebo = 1.71). Using the same bolus dose of 0.15 mg/kg, Kwok et al.…”

Section: Methodsmentioning

confidence: 99%

“…Abdominal sites were assessed by six clinical trials [33,35,39,44,48,50]. Of the three [35,44,50] that studied patients undergoing a major abdominal surgery, all reported a reduction of both opioid consumption and pain scores (of at least a few hours) when administrating ketamine.…”

Section: Methodsmentioning

confidence: 99%

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The Use of Intravenous Infusion or Single Dose of Low-Dose Ketamine for Postoperative Analgesia: A Review of the Current Literature

Jouguelet-Lacoste¹,

Colla²,

Schilling³

et al. 2015

Pain Med

207

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Thirty-nine clinical trials assessed a continuous infusion or a bolus of low-dose ketamine for postoperative analgesia using reduction of pain scores or reduction of the opioid consumption as the primary endpoint. The mean reduction of opioid consumption when using low-dose i.v. infusion ketamine (infusion rate less than 1.2 mg/kg/h) is 40%. Ketamine also reduces pain scores, but the amplitude of the effect is less clear. No major complications have been reported with low-dose i.v. infusion of ketamine up to 48 hours following surgery.

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Section: Methodsmentioning

confidence: 77%

Section: Methodsmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

The Use of Intravenous Infusion or Single Dose of Low-Dose Ketamine for Postoperative Analgesia: A Review of the Current Literature

Jouguelet-Lacoste¹,

Colla²,

Schilling³

et al. 2015

Pain Med

207

View full text Add to dashboard Cite

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Perioperative intravenous ketamine for acute postoperative pain in adults

Brinck

Tiippana

Heesen

et al. 2018

CDSR

183

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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