1
|
Azari L, Hemati H, Tavasolian R, Shahdab S, Tomlinson SM, Babilonia MB, Huang J, Tometich DB, Turner K, Anaraki KS, Jim HSL, Tabriz AA. The Efficacy of Ketamine for Acute and Chronic Pain in Patients with Cancer: A Systematic Review of Randomized Controlled Trials. Healthcare (Basel) 2024; 12:1560. [PMID: 39201120 PMCID: PMC11354190 DOI: 10.3390/healthcare12161560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/02/2024] Open
Abstract
Managing cancer-related pain poses significant challenges, prompting research into alternative approaches such as ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. We conducted a literature review in MEDLINE, EMBASE, and Scopus from 1 January 1982 to 20 October 2023. Abstracts were screened against inclusion criteria, and eligible studies underwent a full-text review. Data was extracted from the included studies, and a framework analysis approach summarized the evidence regarding ketamine's use in patients with cancer. A total of 21 randomized clinical trials were included, and the quality of all the included studies was good or fair. Significant improvements in pain scores and reduced morphine consumption were consistently observed with intravenous ketamine administration for postoperative pain control, particularly when combined with other analgesics such as morphine. Ketamine was less effective when used as an analgesic for chronic pain management, with several studies on neuropathic pain or chemotherapy-induced neuropathy finding minimal significant effect on reduction of pain scores or morphine requirements. The efficacy of ketamine in pain management appears to depend on factors such as dosage, route of administration, and patient population.
Collapse
Affiliation(s)
- Leila Azari
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA;
| | - Homa Hemati
- College of Pharmacy, Tehran University of Medical Sciences, Tehran 1416753955, Iran; (H.H.); (S.S.)
| | - Ronia Tavasolian
- Department of Clinical Science and Nutrition, University of Chester, Chester CH1 4BJ, UK;
| | - Sareh Shahdab
- College of Pharmacy, Tehran University of Medical Sciences, Tehran 1416753955, Iran; (H.H.); (S.S.)
| | | | - Margarita Bobonis Babilonia
- Supportive Care Medicine Department, Behavioral Medicine Services, Moffitt Cancer Center, Tampa, FL 33612, USA;
- Department of Psychiatry and Behavioral Medicine, University of South Florida Morsani College of Medicine, Tampa, FL 33602, USA
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33602, USA; (K.T.); (H.S.L.J.); (A.A.T.)
| | - Jeffrey Huang
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Danielle B. Tometich
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Kea Turner
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33602, USA; (K.T.); (H.S.L.J.); (A.A.T.)
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Kimia Saleh Anaraki
- Department of Internal Medicine, University of Maryland Capital Region, Largo, MD 20774, USA;
| | - Heather S. L. Jim
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33602, USA; (K.T.); (H.S.L.J.); (A.A.T.)
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Amir Alishahi Tabriz
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33602, USA; (K.T.); (H.S.L.J.); (A.A.T.)
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| |
Collapse
|
2
|
Yuksel SS, Chappell AG, Jackson BT, Wescott AB, Ellis MF. "Post Mastectomy Pain Syndrome: A Systematic Review of Prevention Modalities". JPRAS Open 2021; 31:32-49. [PMID: 34926777 PMCID: PMC8651974 DOI: 10.1016/j.jpra.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022] Open
Abstract
Background Post-mastectomy pain syndrome (PMPS) is a surgical complication of breast surgery characterized by chronic neuropathic pain. The development of PMPS is multifactorial and research on its prevention is limited. The objective of this systematic review is to synthesize the existing evidence on interventions for lowering the incidence of persistent neuropathic pain after breast surgery. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the electronic databases of MEDLINE, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov using a combination of database-specific controlled vocabulary and keyword searches. Two reviewers independently screened all unique records. Publications on chronic (>3-month duration) pain after breast cancer-related surgery were included. Studies were classified by modality. Results Our literature search yielded 7092 articles after deduplication. We identified 45 studies that met final inclusion criteria for analysis, including 37 randomized-controlled trials. These studies revealed seven major intervention modalities for prevention of PMPS: physical therapy, mindfulness-based cognitive therapy, oral medications, surgical intervention, anesthesia, nerve blocks, and topical medication therapy. Conclusion High-quality data on preventative techniques for PMPS are required to inform decisions for breast cancer survivors. We present a comprehensive assessment of the modalities available that can help guide breast and reconstructive surgeons employ effective strategies to lower the incidence and severity of PMPS. Our review supports the use of multimodal care involving both a peripherally targeted treatment and centrally acting medication to prevent the development of PMPS.
Collapse
Affiliation(s)
- Selcen S Yuksel
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Brandon T Jackson
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Annie B Wescott
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Marco F Ellis
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago IL
| |
Collapse
|
3
|
Bi Y, Ye Y, Zhu Y, Ma J, Zhang X, Liu B. The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta-Analysis and Systematic Review. Pain Pract 2020; 21:316-332. [PMID: 33150677 DOI: 10.1111/papr.12961] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/16/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short-term and long-term benefits and safety of ketamine after breast surgery. METHOD We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0- to 24-hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. RESULTS Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] -0.83; 95% confidence interval [CI] -1.65, -0.01; P = 0.048) and during the first 24 hours after surgery (WMD -0.65; 95% CI -0.95, -0.35; P < 0.001), and in decreasing opioid consumption (WMD -4.14; 95% CI -8.00, -0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD -0.59; 95% CI, -1.06, -0.12; P = 0.014) and during the first 24 hours after surgery (WMD -0.90; 95% CI -1.27, -0.53; P < 0.001), and in decreasing opioid consumption (WMD - 4.59; 95% CI -5.76, -3.42; P < 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference -0.80; 95% CI - 1.34, -0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043). CONCLUSION Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long-term benefit for preventing postoperative depression and postmastectomy pain syndrome.
Collapse
Affiliation(s)
- Yaodan Bi
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Ye
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yinchao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuqian Zhang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|