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Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies

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Abstract

Introduction

Reducing postoperative opioid consumption is a priority given its impact upon recovery, and the efficacy of ketamine as an opioid-sparing agent in children is debated. The goal of this study was to update a previous meta-analysis on the postoperative opioid-sparing effect of ketamine, adding trial sequential analysis (TSA) and four new studies.

Materials and Methods

A comprehensive literature search was conducted to identify clinical trials that examined ketamine as a perioperative opioid-sparing agent in children and infants. Outcomes measured were postoperative opioid consumption to 48 h (primary outcome: postoperative opioid consumption to 24 h), postoperative pain intensity, postoperative nausea and vomiting and psychotomimetic symptoms. The data were combined to calculate the pooled mean difference, odds ratios or standard mean differences. In addition to this classical meta-analysis approach, a TSA was performed.

Results

Eleven articles were identified, with four added to seven from the previous meta-analysis. Ketamine did not exhibit a global postoperative opioid-sparing effect to 48 postoperative hours, nor did it decrease postoperative pain intensity. This result was confirmed using TSA, which found a lack of power to draw any conclusion regarding the primary outcome of this meta-analysis (postoperative opioid consumption to 24 h). Ketamine did not increase the prevalence of either postoperative nausea and vomiting or psychotomimetic complications.

Conclusions

This meta-analysis did not find a postoperative opioid-sparing effect of ketamine. According to the TSA, this negative result might involve a lack of power of this meta-analysis. Further studies are needed in order to assess the postoperative opioid-sparing effects of ketamine in children.

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Notes

  1. http://www.cochrane-handbook.org/ (Section 9.4.6). Last accessed June 2016.

  2. http://www.cochrane-handbook.org/ (Section 9.5.2). Last accessed June 2016.

  3. http://www.cochrane-handbook.org/ (Section 10.4.3.1). Last access June 2016.

  4. http://www.cochrane-handbook.org/ (Section 10.4.3.1). Last access June 2016.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France

    Daphnée Michelet, Julie Hilly, Alia Skhiri, Rachida Abdat, Thierno Diallo & Souhayl Dahmani

  2. Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Australia

    Christopher Brasher

  3. Paris Diderot University, Paris, France

    Daphnée Michelet, Julie Hilly, Alia Skhiri, Rachida Abdat, Thierno Diallo & Souhayl Dahmani

  4. DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France

    Souhayl Dahmani

  5. Department of Anesthesiology, Intensive Care and Pain Management, Robert Debre Hospital, 48 Bd Sérurier, 75019, Paris, France

    Souhayl Dahmani

Authors
  1. Daphnée Michelet
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  2. Julie Hilly
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  3. Alia Skhiri
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  4. Rachida Abdat
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  5. Thierno Diallo
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  6. Christopher Brasher
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  7. Souhayl Dahmani
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Corresponding author

Correspondence to Souhayl Dahmani.

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Conflict of interest

Daphnée Michelet, Julie Hilly, Alia Skhiri, Rachida Abdat, Thierno Diallo, Christopher Brasher, and Souhayl Dahmani declare no conflict of interest.

Funding

This study was not funded.

Author contributions

D Michelet conceptualized and designed the study, selected articles, evaluated articles, collected data, corrected the manuscript and approved the final manuscript as submitted. J. Hilly selected articles, evaluated articles, collected data, corrected the manuscript and approved the final manuscript as submitted. A. Skhiri selected articles, evaluated articles, collected data, corrected the manuscript and approved the final manuscript as submitted. T. Diallo selected articles, evaluated articles, collected data, corrected the manuscript and approved the final manuscript as submitted. R. Abdat selected articles, evaluated articles, collected data, corrected the manuscript and approved the final manuscript as submitted. C. Brasher verified statistics, corrected the manuscript and approved the final manuscript as submitted. S. Dahmani conceptualized and designed the study, designed the data collection instruments, carried out the initial analyses and verified statistics, drafted the initial manuscript, corrected the manuscript and approved the final manuscript as submitted.

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Michelet, D., Hilly, J., Skhiri, A. et al. Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies. Pediatr Drugs 18, 421–433 (2016). https://doi.org/10.1007/s40272-016-0196-y

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