Ketamine as a component of multimodal analgesia for pain management in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials
Mohamed Ali Chaouch, Mohamed Aziz Daghmouri, Marie-Christine Boutron, Jean‐Marc Ferraz, Sofia Usai, Olivier Soubrane, Marc Beaussier, Guillaume Pourcher, Hani Oweira
Abstract
Introduction: Anaesthesia in morbidly obese people is challenging with a high dose of opioid consumption. This systematic review and meta-analysis of randomised controlled trials (RCTs) summaries evidence comparing ketamine to placebo for pain management after bariatric surgery. Methods: We used PRISMA 2020 and AMSTAR 2 guidelines to conduct this study. The random-effects model was adopted using Review Manager Version 5.3 for pooled estimates. Results: Seven RCTs published between 2009 and 2021 were eligible, including a total of 412 patients (202 patients in the ketamine group and 210 patients in the control group). In the ketamine group total opioid consumption during the first 24 h postoperatively was reduced (mean difference, MD = −5.89; 95% CI [-10.39, −1.38], p = 0.01), lower pain score at 4 h (MD = −0.81; 95% CI [-1.52, −0.10], p = 0.03), pain score at 8 h (MD = −1.00; 95% CI [-1.21, −0.79], p < 0.01), and shorter hospital stay (MD = −0.10; 95% CI [-0.20, −0.01], p = 0.03). There was no significant difference between the two groups regarding duration of anaesthesia (MD = −3.42; 95% CI [-8.62, 1.82], p = 0.20), or sedation score (MD = −0.02; 95% CI [-0.21, 0.17], p = 0.84). As concern the postoperative complications, risks of postoperative nausea and vomiting(OR = 0.75; 95% CI [0.27, 2.04], p = 0.56), hallucinations (OR = 5.47; 95% CI [0.26, 117.23], p = 0.28), dizziness (OR = 1.05; 95% CI [0.14, 7.78], p = 0.96), and euphoria (OR = 5.77; 95% CI [0.65, 51.52], p = 0.12) were not different between the two groups either. Conclusion: Ketamine could be an effective and safe technique for pain management following bariatric surgery. It reduces opioid consumption, postoperative pain, and hospital stay. RegistrationThis review was registered in PROSPERO (CRD42022296484). HIGHLIGHTS This study comparing ketamine infusion or bolus with placebo when used with morphine, paracetamol or tramadol for pain management following bariatric surgery demonstrated that: Ketamine was associated with lower opioid consumption during the 24 h postoperatively. Ketamine decreased VAS scores at H4 and H8, and shorten the hospital stay. Ketamine ensure a similar duration of anaesthesia, postoperative sedation scores, PONV, and postoperative complications rate (hallucinations, headache, euphoria and dizziness).