Abstract
Purpose of Review
Postoperative pain continues to be one of the most common challenges following surgeries. Multimodal analgesia has been of particular focus as non-opioid alternatives have been encouraged due to concerns of the opioid epidemic. Ketamine has been an especially useful adjunct in multimodal pain regimens within the past few decades. This article highlights the current use and advances surrounding the perioperative use of ketamine.
Recent Findings
Ketamine has antidepressive effects at subanesthetic doses. Intraoperative ketamine may be beneficial in reducing postoperative depression. Additionally, newer studies are exploring whether ketamine can be useful in reducing postoperative sleep disturbances.
Summary
Ketamine continues to be a great tool in perioperative pain control, especially during an opioid epidemic. As its use continues to expand and gain more popularity in the perioperative period, more research could shed light on the additional nonanalgesic benefits of ketamine use.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018 Dec 20;12(12):CD012033. https://doi.org/10.1002/14651858.CD012033.pub4. PMID: 30570761; PMCID: PMC6360925. A meta-analysis that suggests that ketamine reduces postoperative opioid consumption.
Wang X, Lin C, Lan L, Liu J. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis. J Clin Anesth. 2021 Feb;68:110071. https://doi.org/10.1016/j.jclinane.2020.110071. Epub 2020 Oct 26. PMID: 33007645.
•• Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):456–66. https://doi.org/10.1097/AAP.0000000000000806. PMID: 29870457; PMCID: PMC6023582.4. Consensus guidelines for the use and dosing of ketamine in the acute pain setting.
Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011;58:911–923. [PubMed] [Google Scholar].
Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, Beach ML. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46. https://doi.org/10.1097/ALN.0b013e3181e90914. PMID: 20693876.
Meyer-Frießem CH, Lipke E, Weibel S, Kranke P, Reichl S, Pogatzki-Zahn EM, Zahn PK, Schnabel A. Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: a systematic review and meta-analysis. J Clin Anesth. 2022 Jun;78:110652. https://doi.org/10.1016/j.jclinane.2022.110652. Epub 2022 Jan 19. PMID: 35065394.
Aghazarian GS, Lind R, Ardila S, Lastrapes L, Ghanem M, Teixeira AF, Jawad MA. Impact of perioperative ketamine on postoperative bariatric surgery opioid use and length of stay. Surg Laparosc Endosc Percutan Tech. 2023;33(1):50–4. https://doi.org/10.1097/SLE.0000000000001132. PMID: 36729562.
Guo Y, Chen L, Gao Z, Zhang M, Liu M, Gao X, Liu Y, Zhang X, Guo N, Sun Y, Wang Y. Is esketamine-based opioid-free anesthesia more superior for postoperative analgesia in obstructive sleep apnea patients undergoing bariatric surgery? A study protocol. Front Med (Lausanne). 2022;15(9):1039042. https://doi.org/10.3389/fmed.2022.1039042. PMID:36457567; PMCID:PMC9705763.
Potvin CA, Green J, Pan B, Al Hamarneh YN, Dillane D. A prospective observational study of the efficacy of ketamine for rescue analgesia in the postanesthesia recovery unit. Can J Anaesth. 2023 Feb 27. English. https://doi.org/10.1007/s12630-023-02398-2. Epub ahead of print. PMID: 36849784.
Doan LV, Li A, Brake L, Ok D, Jee HJ, Park H, Cuevas R, Calvino S, Guth A, Schnabel F, Hiotis K, Axelrod D, Wang J. Single-dose of postoperative ketamine for postoperative pain after mastectomy: a pilot randomized controlled trial. J Pain Res. 2023;14(16):881–92. https://doi.org/10.2147/JPR.S389564.PMID:36942305;PMCID:PMC10024470.
• Guo J, Qiu D, Gu HW, Wang XM, Hashimoto K, Zhang GF, Yang JJ. Efficacy and safety of perioperative application of ketamine on postoperative depression: a meta-analysis of randomized controlled studies. Mol Psychiatry. 2023 Jan 20. https://doi.org/10.1038/s41380-023-01945-z. Epub ahead of print. PMID: 36670198. Ketamine studied in reducing postoperative depression.
• Shen J, Song C, Lu X, Wen Y, Song S, Yu J, Sun J. The effect of low-dose esketamine on pain and post-partum depression after cesarean section: a prospective, randomized, double-blind clinical trial. Front Psychiatry. 2023;4(13):1038379. https://doi.org/10.3389/fpsyt.2022.1038379. PMID: 36683972; PMCID: PMC9845877. Ketamine studied in reducing post operative depression in patients undergoing spinal anesthesia.
•• Mashour GA, Ben Abdallah A, Pryor KO, El-Gabalawy R, Vlisides PE, Jacobsohn E, et al. Intraoperative ketamine for prevention of depressive symptoms after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Br J Anaesth. 2018;121:1075–83. Ketamine studied in reducing postoperative depression.
Zhou Y, Sun W, Zhang G, Wang A, Lin S, Chan MTV, Peng Y, Wang G, Han R. Ketamine alleviates depressive symptoms in patients undergoing intracranial tumor resection: a randomized controlled trial. Anesth Analg. 2021;133(6):1588–97. https://doi.org/10.1213/ANE.0000000000005752. PMID: 34633992.
Qiu D, Wang XM, Yang JJ, Chen S, Yue CB, Hashimoto K, Yang JJ. Effect of intraoperative esketamine infusion on postoperative sleep disturbance after gynecological laparoscopy: a randomized clinical trial. JAMA Netw Open. 2022 Dec 1;5(12):e2244514. https://doi.org/10.1001/jamanetworkopen.2022.44514. PMID: 36454569; PMCID: PMC9716381.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
All authors declare that they have no conflicts of interests or competing interests to disclose.
Human and Animal Rights and Informed Consent
This article does not contain studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Adegbola, A., Gritsenko, K. & Medrano, E.M. Perioperative Use of Ketamine. Curr Pain Headache Rep 27, 445–448 (2023). https://doi.org/10.1007/s11916-023-01128-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11916-023-01128-z