Arif Pendi1, Ryan Field2, Saifal-Deen Farhan1, Martin Eichler3, S Samuel Bederman4. 1. Department of Orthopaedic Surgery, University of California, Irvine, CA. 2. Department of Anesthesiology and Perioperative Care, UCI School of Medicine, University of California, Irvine, CA. 3. Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 4. Restore Orthopedics and Spine Center, Orange, CA.
Abstract
STUDY DESIGN: A meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: The aim of this study was to evaluate the effectiveness of perioperative supplemental ketamine to reduce postoperative opioid analgesic consumption following spine surgery. SUMMARY OF BACKGROUND DATA: Although low-dose supplemental ketamine has been known to reduce pain after surgery, there is conflicting evidence regarding whether ketamine can be effective to reduce opioid consumption following spine surgery. METHODS: Comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials for prospective RCTs, Web of Science, and Scopus. Patients who received supplemental ketamine were compared with the control group in terms of postoperative morphine equivalent consumption, pain scores, and adverse events. Mean differences (MDs) and 95% confidence intervals (CIs) were used to describe continuous outcomes. Odds ratios (ORs) and 95% CIs were applied to dichotomous outcomes. RESULTS: A total of 14 RCTs comprising 649 patients were selected for inclusion into the meta-analysis. Patients who were administered adjunctive ketamine exhibited less cumulative morphine equivalent consumption at 4, 8, 12, and 24 hours following spine surgery (all Ps < 0.05). The ketamine group also reported lower postoperative pain scores at 6, 12, and 24 hours (all Ps < 0.05). None of the adverse events studied attained statistical significance (all Ps > 0.05). CONCLUSION: Supplemental perioperative ketamine reduces postoperative opioid consumption up to 24 hours following spine surgery. LEVEL OF EVIDENCE: 1.
STUDY DESIGN: A meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: The aim of this study was to evaluate the effectiveness of perioperative supplemental ketamine to reduce postoperative opioid analgesic consumption following spine surgery. SUMMARY OF BACKGROUND DATA: Although low-dose supplemental ketamine has been known to reduce pain after surgery, there is conflicting evidence regarding whether ketamine can be effective to reduce opioid consumption following spine surgery. METHODS: Comprehensive search of PubMed, the Cochrane Central Register of Controlled Trials for prospective RCTs, Web of Science, and Scopus. Patients who received supplemental ketamine were compared with the control group in terms of postoperative morphine equivalent consumption, pain scores, and adverse events. Mean differences (MDs) and 95% confidence intervals (CIs) were used to describe continuous outcomes. Odds ratios (ORs) and 95% CIs were applied to dichotomous outcomes. RESULTS: A total of 14 RCTs comprising 649 patients were selected for inclusion into the meta-analysis. Patients who were administered adjunctive ketamine exhibited less cumulative morphine equivalent consumption at 4, 8, 12, and 24 hours following spine surgery (all Ps < 0.05). The ketamine group also reported lower postoperative pain scores at 6, 12, and 24 hours (all Ps < 0.05). None of the adverse events studied attained statistical significance (all Ps > 0.05). CONCLUSION: Supplemental perioperative ketamine reduces postoperative opioid consumption up to 24 hours following spine surgery. LEVEL OF EVIDENCE: 1.
Authors: Kathirvel Subramaniam; Vimal Akhouri; Paul A Glazer; Jacob Rachlin; Lisa Kunze; Mary Cronin; Don Desilva; Christine P Asdourian; Richard A Steinbrook Journal: Pain Med Date: 2011-06-13 Impact factor: 3.750
Authors: Sophie R Pestieau; Julia C Finkel; Mariana M Junqueira; Yao Cheng; John F Lovejoy; Jichuan Wang; Zenaide Quezado Journal: Paediatr Anaesth Date: 2014-06 Impact factor: 2.556
Authors: Lauren K Dunn; Sandeep Yerra; Shenghao Fang; Mark F Hanak; Maren K Leibowitz; Siny Tsang; Marcel E Durieux; Edward C Nemergut; Bhiken I Naik Journal: Anesth Analg Date: 2018-07 Impact factor: 5.108
Authors: Aladine A Elsamadicy; Lefko T Charalambous; Amanda R Sergesketter; Nicolas Drysdale; Syed M Adil; Issac G Freedman; Theresa Williamson; Adam J Kundishora; Joaquin Camara-Quintana; Muhammad M Abd-El-Barr; C Rory Goodwin; Isaac O Karikari Journal: J Spine Surg Date: 2019-03
Authors: Juan F García-Henares; Jose A Moral-Munoz; Alejandro Salazar; Esperanza Del Pozo Journal: Front Pharmacol Date: 2018-08-17 Impact factor: 5.810
Authors: Eric S Schwenk; Eugene R Viscusi; Asokumar Buvanendran; Robert W Hurley; Ajay D Wasan; Samer Narouze; Anuj Bhatia; Fred N Davis; William M Hooten; Steven P Cohen Journal: Reg Anesth Pain Med Date: 2018-07 Impact factor: 6.288