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Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review Subramaniam K; Subramaniam B; Steinbrook RAAnesth Analg 2004[Aug]; 99 (2): 482-95, table of contentsAnimal studies on ketamine and opioid tolerance have shown promising results. Clinical trials have been contradictory. We performed a systematic review of randomized, double-blind clinical trials of ketamine added to opioid analgesia. Thirty-seven trials with 51 treatment arms and 2385 patients were included. Studies were divided into 5 subgroups: IV ketamine as single dose (n = 11), continuous infusion (n = 11), patient-controlled analgesia (PCA) (n = 6), epidural ketamine with opioids (n = 8), and studies in children (n = 4). Outcome measures included pain scores, time to first request for analgesia, supplemental analgesics, and adverse events. Efficacy was estimated by statistical significance (P < 0.05) of outcome measures as reported in studies and also by calculation of weighted mean difference for pain scores during the first 24 h after surgery. As compared to morphine alone, IV PCA with ketamine and morphine did not improve analgesia. Intravenous infusion of ketamine decreased IV and epidural opioid requirements in 6 of 11 studies. A single bolus dose of ketamine decreased opioid requirements in 7 of 11 studies. Five of 8 trials with epidural ketamine showed beneficial effects. Adverse effects were not increased with small dose ketamine. We conclude that small dose ketamine is a safe and useful adjuvant to standard practice opioid-analgesia.|Adult[MESH]|Analgesia, Epidural[MESH]|Analgesia, Patient-Controlled[MESH]|Analgesics, Opioid/administration & dosage/adverse effects/*therapeutic use[MESH]|Anesthetics, Dissociative/administration & dosage/adverse effects/*therapeutic use[MESH]|Child[MESH]|Double-Blind Method[MESH]|Drug Therapy, Combination[MESH]|Humans[MESH]|Infusions, Intravenous[MESH]|Ketamine/administration & dosage/adverse effects/*therapeutic use[MESH]|Pain Measurement[MESH]|Pain/*drug therapy[MESH]|Postoperative Nausea and Vomiting/epidemiology[MESH]|Randomized Controlled Trials as Topic[MESH] |
