Cochrane in CORR®: Perioperative Intravenous Ketamine for Acute Postoperative Pain in Adults.

Abstract

The number of deaths in the United States from opioid overdose, and the number of opioid prescriptions, both have quadrupled since 2000 [3, 4]. After family doctors and internists, orthopaedic surgeons are the third-highest prescribers of opioids among physicians in the United States [9]. The vast majority of surgical patients receive opioids in the peri-operative period, including many for the first time in their lives [4], and it is during this time when patients are at risk for developing opioid dependence. Thus, the concept of multimodal and opioid-reduced or opioid-free perioperative pain management has gained prominence [8]. In fact, a recent editorial in Clinical Orthopaedics and Related Research offered modest approaches to opioid-reduced painmanagement that orthopaedic surgeons should consider including writing smaller prescriptions for shorter periods of time, reassessing whether to use long-acting opioid medications in narcotic-naı̈ve patients, and setting realistic expectations about pain after surgery [7]. Several potential alternatives to opioids have been proposed and investigated, such as ketamine. Ketamine is a medication that provides analgesic, amnestic, and dissociative effects in a dose-dependent manner [11]. There are, however, safety concerns with ketamine including central nervous system symptoms such as hallucinations [10]. In this Cochrane review, the authors investigate the efficacy and safety of ketamine as an adjunct for postoperative pain in adult patients. The authors included 130 blinded, randomized controlled trials (8341 participants) comparing ketamine to either placebo, an opioid medication, or a non-steroidal anti-inflammatory. Overall, the authors found that peri-operative ketamine reduces pain, nausea, vomiting, and the use of opioids after surgery.