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Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

Roger Schmid, Alan N. Sandler, Joel Katz

Pain August 1, 1999 DOI: 10.1016/s0304-3959(99)00044-5 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Systematic review Randomized Double-blind Peer reviewed
Intervention ketamine
Dose bolus dose of less than 2 mg/kg intramuscularly or less than 1 mg/kg intravenously or epidurally; continuous intravenous rate at or below 20 micrograms/kg per minute
Topics Ketamine Esketamine
Keywords Analgesic Anesthesia Nmda receptor Adverse effect Ketamine hydrochloride Randomized controlled trial Opioid Clinical trial Anesthetic Pharmacology Surgery
Citations 547
Key findings Low-dose ketamine may improve postoperative pain management and reduce opioid-related adverse effects when used as an adjunct to other analgesic agents.

Abstract

Ketamine hydrochloride is a well known general anesthetic and short acting analgesic in use for almost 3 decades. The role of the NMDA receptor in the processing of nociceptive input has led naturally to renewed clinical interest in N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine. This paper reviews the use and efficacy of low-dose ketamine in the management of acute postoperative pain. The literature was obtained from a computer search of the MEDLINE database from 1966 through December 1998. Studies were included for review if they were randomized, prospective, controlled, double-blind and reported pain scores. We evaluate the clinical literature and discuss the efficacy of low-dose ketamine in the management of acute postoperative pain when administered alone or in conjunction with other agents via the oral, intramuscular, subcutaneous, intravenous and intraspinal routes. Low-dose ketamine is defined as a bolus dose of less than 2 mg/g when given intramuscularly or less than 1 mg/kg when administered via the intravenous or epidural route. For continuous i.v. administration low-dose ketamine is defined as a rate of < or =20 microg/kg per min. We conclude that ketamine may provide clinicians with a tool to improve postoperative pain management and to reduce opioid related adverse effects. The evidence suggests that low-dose ketamine may play an important role in postoperative pain management when used as an adjunct to local anesthetics, opioids, or other analgesic agents. Further research is required in the following areas: (a) dose-finding studies for ketamine as an adjunct to opioids and local anesthetics (b) efficacy and optimal route of administration (c) the role of S(+)-ketamine; (d) the influence of ketamine on long-term outcome such as chronic pain (e) long-term physical and chemical stability of mixtures containing ketamine (f) spinal toxicity of ketamine and (g) effects of low-dose ketamine on cognitive and memory functioning after surgery.

Comparable studies

Other systematic reviews and meta-analyses on ketamine, most cited first.

Study Year Design Participants
The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis Depressed patients with suicidal ideation at baseline 2017 Systematic review and individual participant data meta-analysis n = 167
Ketamine use: a review Ketamine users 2011 Systematic review
Ketamine and Other NMDA Antagonists: Early Clinical Trials and Possible Mechanisms in Depression Participants with major depression in placebo-controlled, double-blind, randomized... 2015 Systematic review and meta-analysis
Ketamine and postoperative pain – a quantitative systematic review of randomised trials Surgical patients from 25 countries 2004 Systematic review n = 2,839
Side-effects associated with ketamine use in depression: a systematic review. Patients with depression 2018 Systematic review

Citations in the library

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Ketamine Esketamine