The impact of ketamine on pain-related outcomes after thoracotomy: a systematic review with meta-analysis of randomized controlled trials.
Aruzhan Zhaksylyk, Yerkin G Abdildin, Suienish Sultangazin, Aigerim Zhumakanova, Dmitriy Viderman
Frontiers in medicine January 1, 2024 DOI: 10.3389/fmed.2024.1394219 via PubMed
Summary
AI-generated from the abstractAdding ketamine to morphine after thoracotomy reduces acute pain and lowers opioid use. A meta-analysis of nine randomized controlled trials with 556 patients found that patients receiving ketamine plus morphine had significantly less pain at rest and when moving or coughing during the first few days after surgery, and they consumed less morphine overall. The analysis found no data on whether ketamine prevents chronic pain after thoracotomy. The authors call for larger, standardized trials to assess both short- and long-term effects.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 556 |
| Population | Adults undergoing thoracotomy |
| Intervention | Ketamine plus morphine |
| Topics | Ketamine |
| Keywords | Acute pain Chronic pain Outcomes Pain management Thoracic surgery |
| Key finding | Ketamine plus morphine significantly reduces acute pain and opioid consumption after thoracotomy compared with morphine alone. |
Abstract
This meta-analysis aims to examine how effective ketamine is in the management of acute and preventing chronic post-thoracotomy pain by synthesizing the available research. A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library till May 2023. Randomized Controlled Trials (RCT) examining the influence of ketamine on post-thoracotomy pain in adults were included. The intervention group included ketamine plus morphine, while the control group included morphine only. The outcome measures were opioid intake and pain scores at rest and on moving/coughing. Evidence quality was evaluated using the Cochrane Risk of Bias and GRADE assessment. Nine articles comprising 556 patients were selected for meta-analysis. The intervention group had a significant decrease in pain at rest (Std. Mean Difference (SMD = -0.60 with 95% CI [-0.83, -0.37]) and on movement/cough (SMD = -0.73 [-1.27, -0.18]) in the first postoperative days. Also, the ketamine group had lower opioid consumption (mg) in comparison with controls (SMD = -2.75 [-4.14, -1.36], p-value = 0.0001) in postoperative days 1-3. There was no data to assess the long-term effect of ketamine on chronic pain. This meta-analysis shows that ketamine use can lower acute pain levels and morphine use after thoracotomy. In the future, larger RCTs using standardized methods and assessing both short-term and long-term analgesic effects of ketamine are necessary to deepen the understanding of the issue.