Efficacy of intravenous ketamine for neuropathic pain: a systematic review and meta-analysis of randomized clinical trials.

IF 1.7 Q4 CLINICAL NEUROLOGY

Pain management Pub Date : 2026-08-11 DOI:10.1080/17581869.2026.2714980

Márcio José Leão Nunes Filho, Eduardo Silva Reis Barreto, Cesar Romero Antunes Júnior, Luiz Gustavo Albuquerque Mello de Oliveira, João Pedro Fernandes Gonçalves, Gabriel Teles de Oliveira Piñeiro, Clara Garrido Kraychete, Liana Maria Torres de Araujo Azi, Liliane Elze Falcão Lins-Kusterer, Durval Campos Kraychete

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Abstract

Aim: This study evaluated the efficacy of intravenous ketamine for chronic neuropathic pain through a systematic review and meta-analysis of randomized clinical trials.

Methods: Searches were conducted in PubMed, Cochrane CENTRAL, and EMBASE until March 2026 in accordance with the PRISMA framework: adult patients with chronic neuropathic pain, intravenous ketamine as the intervention, placebo as the comparator, and pain relief outcomes.

Results: Fifteen randomized clinical trials (n = 251) were included in the systematic review, of which six trials (n = 135) were included in the primary outcome meta-analysis. Ketamine doses ranged from 60 µg/kg to 1 mg/kg. Pooled analysis showed that intravenous ketamine was superior to placebo in achieving a ≥50% reduction in pain intensity (RR = 2.79, 95% CI: 1.47-5.30; I² = 28.3%), with a more pronounced effect in studies using a standardized dose of 400 µg/kg (RR = 5.68; 95% CI: 2.02-15.99; I² = 0%). However, ketamine was associated with a higher incidence of adverse effects compared to placebo (RR = 3.27; 95% CI: 2.20-4.84; I² = 20.1%).

Conclusion: Overall, intravenous ketamine demonstrates the potential to provide effective short-term pain relief. Although adverse events were more frequent, they were generally mild and transient. Methodological heterogeneity and small sample sizes limit the generalizability of these findings.Protocol registration: The www.crd.york.ac.uk/prospero identifier is CRD42021229758.

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静脉注射氯胺酮治疗神经性疼痛的疗效：随机临床试验的系统回顾和荟萃分析。

目的：本研究通过对随机临床试验的系统回顾和荟萃分析，评价静脉注射氯胺酮治疗慢性神经性疼痛的疗效。方法：根据PRISMA框架，在PubMed、Cochrane CENTRAL和EMBASE中进行检索，直到2026年3月：慢性神经性疼痛的成人患者，静脉注射氯胺酮作为干预，安慰剂作为对照，疼痛缓解结果。结果：系统评价纳入15项随机临床试验（n = 251），其中6项试验（n = 135）纳入主要结局荟萃分析。氯胺酮的剂量从60µg/kg到1 mg/kg不等。合并分析显示，静脉注射氯胺酮在疼痛强度降低≥50%方面优于安慰剂（RR = 2.79, 95% CI: 1.47-5.30; I2 = 28.3%），在使用400µg/kg标准剂量的研究中效果更明显（RR = 5.68; 95% CI: 2.02-15.99; I2 = 0%）。然而，与安慰剂相比，氯胺酮的不良反应发生率更高（RR = 3.27; 95% CI: 2.20-4.84; I2 = 20.1%）。结论：总的来说，静脉注射氯胺酮显示了提供有效的短期疼痛缓解的潜力。虽然不良事件更频繁，但它们通常是轻微和短暂的。方法的异质性和小样本量限制了这些发现的普遍性。协议注册：www.crd.york.ac.uk/prospero标识为CRD42021229758。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain management CLINICAL NEUROLOGY-

CiteScore

2.90

自引率

5.90%

发文量