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

Lijin Zhou, Honghao Yang, Yong Hai, Yunzhong Cheng, Lijin Zhou, Honghao Yang, Yong Hai, Yunzhong Cheng

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.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2022 Lijin Zhou et al.

Figures

Figure 1
Figure 1
Flow diagram depicting the literature review, search strategy, and selection process.
Figure 2
Figure 2
Risk of bias. (a) A summary table of each risk of bias item for each study; (b) a plot of the distribution of each risk of bias item. “+”: low risk of bias; “?”: unclear risk of bias; “–”: high risk of bias.
Figure 3
Figure 3
Forest plot of the pain intensity at rest for the ketamine group and control group. (a) 6 h; (b) 12 h; (c) 24 h; (d) 48 h.
Figure 4
Figure 4
Forest plot of the pain intensity during mobilization for the ketamine group and control group. (a) 6 h; (b) 12 h; (c) 24 h; (d) 48 h.
Figure 5
Figure 5
Forest plot of the cumulative opioid consumption for the ketamine group and control group. (a) First 12 h; (b) first 24 h; (c) first 48 h.
Figure 6
Figure 6
Forest plot of the time to first request for analgesic after surgery for the ketamine group and control group.
Figure 7
Figure 7
Forest plot of the incidence of adverse events for the ketamine group and control group. (a) CNS adverse events; (b) PONV.

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