Hemodynamic response to sub-anesthetic doses of ketamine for postoperative pain: systematic review

  • Adriana Margarita Cadavid Puentes Pain Medicine Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0002-2997-2546
  • Julio Ernesto Camelo Rincón Pain Medicine Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0003-2336-0343
  • Fabián David Casas Arroyave Anesthesiology Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0002-3274-0754
  • Edna Fernanda Chávez Lasso a. Pain Medicine Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia; b. Anesthesiology Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia.
  • Maritza Leyton Ortega a. Pain Medicine Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia; b. Anesthesiology Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia.
  • Alejandro Tovar Gutiérrez Pain Medicine Service, Hospital Universitario San Vicente Fundación, School of Medicine, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0002-5037-476X
Keywords: Ketamine, Postoperative pain, Hemodynamics, Blood pressure, Heart rate, Opioids, Psychomimetic, Anesthesiology

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

How to Cite
1.
Cadavid Puentes AM, Camelo Rincón JE, Casas Arroyave FD, Chávez Lasso EF, Leyton Ortega M, Tovar Gutiérrez A. Hemodynamic response to sub-anesthetic doses of ketamine for postoperative pain: systematic review. Colomb. J. Anesthesiol. [Internet]. 2024 Feb. 12 [cited 2024 Feb. 28];. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1099

Downloads

Download data is not yet available.
Published
2024-02-12
How to Cite
1.
Cadavid Puentes AM, Camelo Rincón JE, Casas Arroyave FD, Chávez Lasso EF, Leyton Ortega M, Tovar Gutiérrez A. Hemodynamic response to sub-anesthetic doses of ketamine for postoperative pain: systematic review. Colomb. J. Anesthesiol. [Internet]. 2024 Feb. 12 [cited 2024 Feb. 28];. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1099
Section
Systematic review

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: