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Review
. 2023 Nov;67(10):1306-1321.
doi: 10.1111/aas.14307. Epub 2023 Jul 19.

Ketamine for postoperative pain treatment in spinal surgery: Systematic review with meta-analysis and trial sequential analysis

Anders Schou Tornøe  1 , Alison Holten Pind  1 , Christina Cleveland Westerdahl Laursen  1 , Cheme Andersen  1 , Mathias Maagaard  1 , Ole Mathiesen  1   2
Affiliations
Review

Ketamine for postoperative pain treatment in spinal surgery: Systematic review with meta-analysis and trial sequential analysis

Anders Schou Tornøe et al. Acta Anaesthesiol Scand. 2023 Nov.

Abstract

Aim: We aimed to assess the beneficial and harmful effects of perioperative pain treatment with ketamine in patients undergoing spinal surgery.

Methods: We searched Medline, Embase, and CENTRAL from inception until 15 February 2023 for randomised clinical trials comparing ketamine with placebo or no intervention in patients undergoing spinal surgery. The primary outcomes were cumulative opioid consumption at 24 h postoperatively and serious adverse events. We adhered to recommendations of the Cochrane Collaboration and performed meta-analysis, Trial Sequential Analysis (TSA) to assess the risks of random errors, risk of bias assessment to evaluate the risks of systematic errors, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: We included a total of 28 randomised clinical trials enrolling 2110 participants providing data for our pre-defined outcomes. Twenty-three trials enrolled adult participants and 5 trials enrolled paediatric participants. Three trials were at low risk of bias. Meta-analysis and TSA of trials including adults showed that ketamine versus placebo or no intervention seemed to reduce the cumulative 24-h opioid consumption (mean difference -17.57 mg; TSA-adjusted 95% confidence interval, -24.22 to -10.92; p < .01; low certainty of evidence), and there was no evidence of a difference of ketamine versus placebo or no intervention on the risk of serious adverse events (risk ratio 2.16; 96.7% confidence interval, 0.35 to 13.17; p = .36; very low certainty of evidence).

Conclusion: In adults undergoing spinal surgery, ketamine may reduce cumulative 24-h opioid consumption. Ketamine may increase the occurrence of serious adverse events, but the evidence was very uncertain.

Keywords: ketamine; meta-analyses; postoperative pain; spine surgery; systematic review.

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References

REFERENCES

    1. Reisener MJ, Pumberger M, Shue J, Girardi FP, Hughes AP. Trends in lumbar spinal fusion-a literature review. J Spine Surg. 2020;6(4):752-761. doi:10.21037/jss-20-492
    1. Murphy GS, Avram MJ, Greenberg SB, et al. Perioperative methadone and ketamine for postoperative pain control in spinal surgical patients: a randomized, double-blind placebo-controlled trial. Anesthesiology. 2021;134(5):697-708. doi:10.1097/aln.0000000000003743
    1. Nielsen RV, Fomsgaard JS, Siegel H, et al. Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency: a randomized, blinded trial. Pain. 2017;158(3):463-470. doi:10.1097/j.pain.0000000000000782
    1. Brill S, Ginosar Y, Davidson EM. Perioperative management of chronic pain patients with opioid dependency. Curr Opin Anaesthesiol. 2006;19(3):325-331. doi:10.1097/01.aco.0000192813.38236.99
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-944. doi:10.1097/ALN.0b013e31828866b3

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