Hemodynamic response to sub-anesthetic doses of ketamine for postoperative pain: systematic review
Abstract
Introduction: Low-dose ketamine infusions have shown analgesic effectiveness for the management of postoperative pain. The impact of low-dose ketamine infusions on cardiovascular response is dose-dependent and requires a better knowledge about its effects on this population.
Objective: To conduct a systematic review to describe changes in systolic, diastolic and mean arterial pressure, and heart rate 24, 48 and 72 hours after surgery.
Methods: Randomized, controlled trials were reviewed in the Cochrane Library, PubMed, EMBASE, SciELO, Lilacs and grey literature on low-dose ketamine infusions for the study variables. The quality of the studies was assessed using the Cochrane’s risk of bias tool.
Results: Six randomized, controlled trials with 641 patients were included. Low-quality evidence was found suggestive of a lack of certainty of any significant differences in the systolic blood pressure variables at 24 hours (mean standard deviation -1.00, 95 % CI: -7.27 to 5.27). A statistically significant higher mean heart rate at 24 hours was identified in the low-dose ketamine infusion group, (mean standard deviation 1.64 95 % CI: 0.38 to 2.90) which did not reach clinical significance. A lower pain level and less use of opioids was identified in the low-dose ketamine infusion group.
Conclusion: Low quality evidence was found, suggesting that low-dose ketamine infusions are not associated with significant changes in blood pressure or heart rate 24 – 48 hours after surgery. It is important to individualize cardiovascular risk for each case, before initiating treatment.
References
Schwenk ES, Viscusi ER, Buvanendran A, Hurley R, Wasan A, Narouze S, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):456-66. doi: https://doi:10.1097/AAP.0000000000000806
Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med. 2015;16(2):383-403. doi: https://doi:10.1111/pme.12619
Zhou L, Yang H, Hai Y, Cheng Y. Perioperative low-dose ketamine for postoperative pain management in spine surgery: A systematic review and meta-analysis of randomized controlled trials. Pain Res Manag. 2022;2022:1507097. doi: https://doi:10.1155/2022/1507097
Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12(12):CD012033. doi: http://doi:10.1002/14651858.CD012033.pub4
Gorlin AW, Rosenfeld DM, Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia. J Anaesthesiol Clin Pharmacol. 2016;32(2):160-7. doi: https://doi:10.4103/0970-9185.182085
Domino EF. Taming the ketamine tiger. 1965. Anesthesiology. 2010;113(3):678- 684. doi: https://doi:10.1097/ALN.0b013e3181ed09a2
Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med. 2008;(26):985-1028. doi: https://10.1016/j.ajem.2007.12.005
Vankawala J, Napoles G, Ávila-Quintero VJ, Ramirez K, Flores J, Bloch M, Dwyer J. Meta-Analysis: hemodynamic responses to sub-anesthetic doses of ketamine in patients with psychiatric disorders. Front Psychiatry. 2021;12:549080. doi: https://doi:10.3389/fpsyt.2021.549080
Kamp J, Jonkman K, Van Velzen M, Aarts L, Niesters M, Dahan A, Olofsen E. Pharmacokinetics of ketamine and its major metabolites norketamine, hydroxynorketamine, and dehydronorketamine: a model-based analysis. Br J Anaesth. 2020;125(5):750-61. doi: https://doi:10.1016/j.bja.2020.06.067
Webb AR, Skinner BS, Leong S,Kolawolw H, Crofts T, Taverner M, Burn S. The addition of a small-dose ketamine infusion to tramadol for postoperative analgesia: a double-blinded, placebo- controlled, randomized trial after abdominal surgery. Anesth Analg. 2007;104(4):912-17. doi: https://doi:10.1213/01.ane.0000256961.01813.da
Aveline C, Gautier JF, Vautier P, Cognet F, Hetet HL, Attali JY, Leconte V, Leborgne P, Bonnet F. Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam. Eur J Pain. 2009;13(6):613-9. doi: https://doi:10.1016/j.ejpain.2008.08.003
Deng GF, Zheng JP, Wang S, Tian B, Zhang SG. Remifentanil combined with low-dose ketamine for postoperative analgesia of lower limb fracture: a double-blind, controlled study. Chin J Traumatol. 2009;12(4):223-27. doi: https://doi.org/10.3760/cma.j.issn.1008-1275.2009.04.007
Joseph C, Gaillat F, Duponq R, Lieven R, Baumstarck K, Thomas P, Penot-Ragon C, Kerbaul F. Is there any benefit to adding intravenous ketamine to patient-controlled epidural analgesia after thoracic surgery? A randomized double-blind study. Eur J Cardiothorac Surg. 2012;42(4):e58-e65. doi: https://doi:10.1093/ejcts/ezs398
Garg N, Panda NB, Gandhi KA, Bhagat H, Batra YK, Grover VK, Chhabra R. Comparison of small dose ketamine and dexmedetomidine infusion for postoperative analgesia in spine surgery--a prospective randomized double-blind placebo controlled study. J Neurosurg Anesthesiol. 2016;28(1):27-31. doi: http://doi:10.1097/ANA.0000000000000193
Arıkan M, Aslan B, Arıkan O, Horasanlı E, But A. Comparison of the effects of magnesium and ketamine on postoperative pain and morphine consumption. A double-blind randomized controlled clinical study. Acta Cir Bras. 2016;31(1):67-73. doi: https://doi:10.1590/S0102-865020160010000010
Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain. 1999;82(2):111-25. doi: https://doi:10.1016/S0304-3959(99)00044
Kaur S, Saroa R, Aggarwal S. Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia. J Nat Sci Biol Med. 2015;6(2):378-82. doi: https://doi:10.4103/0976-9668.160012
Wang X, Lin C, Lan L, Liu J. Perioperative intravenous S-ketamine for acute postoperative pain in adults: A systematic review and meta-analysis. J Clin Anesth. 2021;68:110071. doi: https://doi:10.1016/j.jclinane.2020.110071
Zakine J, Samarcq D, Lorne E, Moubarak M, Montravers P, Beloucif S, Dupont H. Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study. Anesth Analg. 2008;106(6):1856-61. doi: https://doi:10.1213/ane.0b013e3181732776
Gupta A, Mo K, Movsik J, Al Farii H. Statistical fragility of ketamine infusion during scoliosis surgery to reduce opioid tolerance and postoperative pain. World Neurosurg. 2022;164:135-42. doi: https://doi:10.1016/j.wneu.2022.04.121
Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The impact of hypertension on patients with acute coronary syndromes. Int J Hypertens. 2011;2011:563657. doi: https://doi:10.4061/2011/563657
Goddard K, Simpson C, Bedy SM, Ghadban R, Stilley J. Effect of ketamine on cardiovascular function during procedural sedation of adults. Cureus. 2021;13(3):e14228. doi: https://doi:10.7759/cureus.14228
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