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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 7, Issue 1

Issues

Intra- and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis

Elena Klatt
  • Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University of Basel Hospital, CH-4031 Basel Switzerland
  • Other articles by this author:
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/ Thomas Zumbrunn / Oliver Bandschapp
  • Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University of Basel Hospital, CH-4031 Basel Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Thierry Girard
  • Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University of Basel Hospital, CH-4031 Basel Switzerland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Wilhelm Ruppen
  • Corresponding author
  • Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University of Basel Hospital, CH-4031 Basel Switzerland
  • Email
  • Other articles by this author:
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Published Online: 2015-04-01 | DOI: https://doi.org/10.1016/j.sjpain.2014.12.005

Abstract

Background and aims

The development of postoperative chronic pain (POCP) after surgery is a major problem with a considerable socioeconomic impact. It is defined as pain lasting more than the usual healing, often more than 2–6 months. Recent systematic reviews and meta-analyses demonstrate that the N-methyl-D-aspartate-receptor antagonist ketamine given peri- and intraoperatively can reduce immediate postoperative pain, especially if severe postoperative pain is expected and regional anaesthesia techniques are impossible. However, the results concerning the role of ketamine in preventing chronic postoperative pain are conflicting. The aim of this study was to perform a systematic review and a pooled analysis to determine if peri- and intraoperative ketamine can reduce the incidence of chronic postoperative pain.

Methods

Electronic searches of PubMed, EMBASE and Cochrane including data until September 2013 were conducted. Subsequently, the titles and abstracts were read, and reference lists of reviews and retrieved studies were reviewed for additional studies. Where necessary, authors were contacted to obtain raw data for statistical analysis. Papers reporting on ketamine used in the intra- and postoperative setting with pain measured at least 4 weeks after surgery were identified. For meta-analysis of pain after 1, 3, 6 and 12 months, the results were summarised in a forest plot, indicating the number of patients with and without pain in the ketamine and the control groups. The cut-off value used for the VAS/NRS scales was 3 (range 0–10), which is a generally well-accepted value with clinical impact in view of quality of life.

Results

Our analysis identified ten papers for the comprehensive meta-analysis, including a total of 784 patients. Three papers, which included a total of 303 patients, reported a positive outcome concerning persistent postsurgical pain. In the analysis, only one of nine pooled estimates of postoperative pain at rest or in motion after 1, 3, 6 or 12 months, defined as a value ≥3 on a visual analogue scale of 0–10, indicated a marginally significant pain reduction.

Conclusions

Based on the currently available data, there is currently not sufficient evidence to support a reduction in chronic pain due to perioperative administration of ketamine. Only the analysis of postoperative pain at rest after 1 month resulted in a marginally significant reduction of chronic postoperative pain using ketamine in the perioperative setting.

Implications

It can be hypothesised, that regional anaesthesia in addition to the administration of perioperative ketamine might have a preventive effect on the development of persistent postsurgical pain. An additional high-quality pain relief intra- and postoperatively as well after discharge could be more effective than any particular analgesic method per se. It is an assumption that a low dose infusion ketamine has to be administered for more than 72 h to reduce the risk of chronic postoperative pain.

Keywords: Intra- and postoperative ketamine; Chronic pain; Prevention of chronic pain; Meta-analysis

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About the article

Tel.: +41 61 328 6496; fax: +41 61 265 7320


Received: 2014-09-21

Revised: 2014-12-19

Accepted: 2014-12-22

Published Online: 2015-04-01

Published in Print: 2015-04-01


Summary statement A systematic review with a comprehensive meta-analysis demonstrated that intra- and postoperatively administered ketamine is not effective to prevent chronic postoperative pain.

Funding Support was provided solely from departmental sources.

Conflict of interest There are no conflicts of interest to declare.


Citation Information: Scandinavian Journal of Pain, Volume 7, Issue 1, Pages 42–54, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2014.12.005.

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