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Can J Anaesth. 2016 Mar;63(3):311-25. doi: 10.1007/s12630-015-0551-4. Epub 2015 Dec 10.

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials.

Wang L1,2,3, Johnston B4,5, Kaushal A6,7, Cheng D1,8, Zhu F1, Martin J9,10,11,12.

Author information

1
Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), Western University, London, ON, Canada.
2
Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
3
Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China.
4
Department of Anesthesia and Pain Medicine, and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
5
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
6
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
7
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
8
Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada.
9
Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), Western University, London, ON, Canada. jmarti83@uwo.ca.
10
Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada. jmarti83@uwo.ca.
11
Department of Epidemiology & Biostatistics, Western University, London, ON, Canada. jmarti83@uwo.ca.
12
Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI), and Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, Room B3-412, 339 Windermere Road, London, ON, N6A 5A5, Canada. jmarti83@uwo.ca.

Abstract

PURPOSE:

To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery.

SOURCE:

We systematically searched six databases up to June 2, 2015 for randomized controlled trials (RCTs) comparing ketamine plus morphine/hydromorphone PCA vs morphine/hydromorphone PCA for postoperative pain in adults.

PRINCIPAL FINDINGS:

Thirty-six RCTs including 2,502 patients proved eligible, and 22 of these were at low risk of bias. The addition of ketamine to morphine/hydromorphone PCA decreased postoperative pain intensity at six to 72 hr when measured at rest (weighted mean difference [WMD] on a 10-cm visual analogue scale ranged from -0.4 to -1.3 cm) and during mobilization (WMD ranged from -0.4 to -0.5 cm). Adjunctive ketamine also significantly reduced cumulative morphine consumption at 24-72 hr by approximately 5-20 mg. Predefined subgroup analyses and meta-regression did not detect significant differences across subgroups, including a dose-response relationship. There was no significant difference in patient satisfaction scores at 24 and 48 hr. Nevertheless, the addition of ketamine to morphine/hydromorphone PCA significantly reduced postoperative nausea and vomiting (relative risk, 0.71; 95% confidence interval [CI], 0.60 to 0.85; absolute risk reduction, 8.9%; 95% CI, 4.6 to 12.2). Significant effects on other adverse events (e.g., hallucinations, vivid dreams) were not detected, though only a few studies reported on them.

CONCLUSIONS:

Adding ketamine to morphine/hydromorphone PCA provides a small improvement in postoperative analgesia while reducing opioid requirements. Adjunctive ketamine also reduces postoperative nausea and vomiting without a detected increase in other adverse effects; however, adverse events were probably underreported.

PMID:
26659198
DOI:
10.1007/s12630-015-0551-4
[Indexed for MEDLINE]

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