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Zhaksylyk A, Abdildin YG, Sultangazin S, Zhumakanova A, Viderman D. The impact of ketamine on pain-related outcomes after thoracotomy: a systematic review with meta-analysis of randomized controlled trials. Front Med (Lausanne) 2024; 11:1394219. [PMID: 38919936 PMCID: PMC11196606 DOI: 10.3389/fmed.2024.1394219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/15/2024] [Indexed: 06/27/2024] Open
Abstract
Objective This meta-analysis aims to examine how effective ketamine is in the management of acute and preventing chronic post-thoracotomy pain by synthesizing the available research. Method A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library till May 2023. Randomized Controlled Trials (RCT) examining the influence of ketamine on post-thoracotomy pain in adults were included. The intervention group included ketamine plus morphine, while the control group included morphine only. The outcome measures were opioid intake and pain scores at rest and on moving/coughing. Evidence quality was evaluated using the Cochrane Risk of Bias and GRADE assessment. Results Nine articles comprising 556 patients were selected for meta-analysis. The intervention group had a significant decrease in pain at rest (Std. Mean Difference (SMD = -0.60 with 95% CI [-0.83, -0.37]) and on movement/cough (SMD = -0.73 [-1.27, -0.18]) in the first postoperative days. Also, the ketamine group had lower opioid consumption (mg) in comparison with controls (SMD = -2.75 [-4.14, -1.36], p-value = 0.0001) in postoperative days 1-3. There was no data to assess the long-term effect of ketamine on chronic pain. Conclusion This meta-analysis shows that ketamine use can lower acute pain levels and morphine use after thoracotomy. In the future, larger RCTs using standardized methods and assessing both short-term and long-term analgesic effects of ketamine are necessary to deepen the understanding of the issue.
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Affiliation(s)
- Aruzhan Zhaksylyk
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Suienish Sultangazin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Aigerim Zhumakanova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Dmitriy Viderman
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, Astana, Kazakhstan
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Schauer SG, Naylor JF, Davis WT, Borgman MA, April MD. An Analysis of Prolonged, Continuous Ketamine Infusions. Mil Med 2021; 187:e547-e553. [PMID: 33492388 DOI: 10.1093/milmed/usaa481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Opioids carry high risk of dependence, and patients can rapidly build tolerance after repetitive dosing. Low-dose ketamine is an analgesic agent alternative that provides more hemodynamic stability. We sought to describe the effects of prolonged ketamine use in non-burn patients. MATERIALS AND METHODS We queried the electronic health system at the Brooke Army Medical Center for patient encounters with ketamine infusions lasting >72 hours. We abstracted data describing demographics, vital signs, ketamine infusion dose and duration, and discharge diagnoses potentially relevant to ketamine side effects. RESULTS We identified 194 subjects who met the study inclusion criteria. The median age was 39 years, most were male (67.0%), and most were primarily admitted for a non-trauma reason (59.2%). The mean ketamine drip strength was 43.9 mg/h (95% CI, 36.7-51.1; range 0.1-341.6) and the mean drip length was 130.8 hours (95% CI, 120.3-141.2; range 71-493). Most subjects underwent mechanical ventilation (56.1%) at some point during the infusion and most survived to hospital discharge (83.5%). On a per-day basis, the average heart rate was 93 beats per minute, systolic blood pressure was 128 mmHg, diastolic blood pressure was 71 mmHg, oxygen saturation was 96%, and respiratory rate was 22 respirations per minute. CONCLUSIONS We demonstrate that continuous ketamine infusions provide a useful adjunct for analgesia and/or sedation. Further development of this adjunct modality may serve as an alternative agent to opioids.
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Affiliation(s)
- Steven G Schauer
- Combat Mortality Prevention Division, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, USA.,Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.,Department of Pediatrics, 59th Medical Wing, JBSA Lackland, San Antonio, TX, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason F Naylor
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis McChord, Tacoma, Washington, DC, USA
| | - William T Davis
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.,Department of Pediatrics, 59th Medical Wing, JBSA Lackland, San Antonio, TX, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Matthew A Borgman
- 2nd Brigade, 4th Infantry Division, Fort Carson, Colorado Springs, CO, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael D April
- 2nd Brigade, 4th Infantry Division, Fort Carson, Colorado Springs, CO, USA
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