The effect of perioperative ketamine and esketamine administration on postoperative nausea and vomiting in patients undergoing general anesthesia: a systematic review and meta-analysis.
Korean journal of anesthesiology – May 08, 2025
Source: PubMed
Summary
Patients undergoing general anesthesia often struggle with post-surgery nausea, affecting recovery and comfort. New research reveals that ketamine and esketamine, while helpful in reducing nausea compared to opioid painkillers, may not be the best overall solution. Analysis of 6,600+ patients showed these medications actually increased nausea when compared to non-opioid options, and doubled the risk of hallucinations and drowsiness.
Abstract
The effects of perioperative ketamine and esketamine on postoperative nausea and vomiting (PONV) remain unclear. This study aimed to clarify their impact on PONV and related adverse events. We performed a meta-analysis of randomized controlled trials (RCTs) and observational studies comparing ketamine or esketamine with control agents. The primary outcome was a pooled analysis of PONV and nausea-only data. PONV, postoperative nausea (PON), and postoperative vomiting (POV) were also analyzed separately. Subgroup analyses were conducted by comparator type (placebo, opioid, or non-opioid) and dose categories. Meta-regression was used to assess dose-response relationships. Fifty-five studies (n = 6,676) were included. Ketamine and esketamine did not significantly reduce the incidence of pooled PONV risk (risk ratio [RR]: 0.95, 95% CI [0.87, 1.04], P = 0.274). No benefit was found versus placebo. Compared with opioids, PONV was reduced (RR: 0.50, 95% CI [0.32, 0.77], P = 0.002), but not in the pooled analysis (RR: 0.69, 95% CI [0.43, 1.08], P = 0.107). Conversely, compared with non-opioid controls, ketamine/esketamine increased the pooled PONV risk (RR: 1.46, 95% CI [1.03, 2.05], P = 0.032). No significant dose-response relationship was found. Both agents increased hallucinations (RR: 1.73; 95% CI [1.35, 2.20], P = 0.0002) and drowsiness (RR: 2.18, 95% CI [1.13-4.21], P = 0.024). Ketamine and esketamine did not significantly reduce PONV overall. While they showed benefits compared with opioid-based regimens, they may be less effective than non-opioid adjuvants. However, their neuropsychiatric and sedative risks warrant cautious use.