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STUDY DESIGN
Meta-analysis of randomized controlled trials.
OBJECTIVE
To evaluate the effectiveness of perioperative supplemental ketamine
to reduce postoperative opioid analgesic consumption following spine
surgery.
SUMMARY OF BACKGROUND DATA
Although low-dose supplemental ketamine has been known to reduce
pain after surgery, there is conflicting evidence regarding whether
ketamine can be effective to reduce opioid consumption following
spine surgery.
METHODS
Comprehensive search of PubMed, the Cochrane Central Register of
Controlled Trials for prospective randomized controlled trials
(RCTs), Web of Science, and Scopus. Patients that received
supplemental ketamine were compared to the control group in terms of
postoperative morphine equivalent consumption, pain scores, and
adverse events. Mean differences (MD) and 95% confidence intervals
(CI) were used to describe continuous outcomes. Odds Ratios (OR) and
95% CIs were applied to dichotomous outcomes.
RESULTS
A total of 14 RCTs comprising 649 patients were selected for
inclusion into the meta-analysis. Patients that were administered
adjunctive ketamine exhibited less cumulative morphine equivalent
consumption at 4, 8, 12, and 24 hours following spine surgery (all
ps < 0.05). The ketamine group also reported lower
postoperative pain scores at 6, 12, and 24 hours (all
ps < 0.05). None of the adverse events studied attained
statistical significance (all ps>0.05).
CONCLUSIONS
Supplemental perioperative ketamine reduces postoperative opioid
consumption up to 24 hours following spine surgery.
LEVEL OF EVIDENCE
1.
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