C. M. Trevino1, K. Gibbons1, C. Mitchell1, W. Peppard1 1Medical College Of Wisconsin,Surgery,Milwaukee, WI, USA
Introduction: Opioids are often prescribed for acute treatment of severe pain in the post-operative setting. Opioids have the propensity to cause addiction and many patients who utilize them become dependent, even patients undergoing surgery. It has been shown that 10-20% of surgical patients who are opioid naïve pre-operatively became dependent on opioids after surgery. Multimodal analgesia regimens have been implemented to limit opioid consumption perioperatively. Ketamine has been studied as an opioid-sparing agent, reducing acute adverse effects, and long-term dependence. The primary objective of this study was to determine the clinical correlation between the opioid sparing effects and incidence of nausea and vomiting in perioperative ketamine use at 24 hours post-op.
Methods: A systematic review was conducted utilizing studies that evaluated perioperative ketamine use compared to an opioid therapy control group. Included studies must have reported total opioid use and incidence of nausea and vomiting at 24 hours post-op in both control and ketamine groups. Studies that were excluded failed to report this data or did not report the data at time interval of interest.
Results: Overall, 24 studies where eligible and completed between 1993-2013, with 1456 patients available for analysis. A total of 753 patients received ketamine perioperatively for multimodal pain management (ketamine group) and 673 patients received traditional opioid pain regimens (control group). At 24 hours, the ketamine group experienced 35% relative reduction of total opioid use compared to the control group. Patients in the ketamine group also experienced less nausea and vomiting compared to the control group (19% vs 30%, p<0.001), leading to a 37% relative risk reduction of nausea and vomiting when ketamine was utilized perioperatively. Despite these findings, there was no significant correlation (correlation coefficient r = -0.31) between post-operative nausea and vomiting with the reduction of opioid use at 24-hours.
Conclusion: The addition of ketamine to perioperative, multimodal analgesia regimens leads to significant reductions in total opioid use and nausea and vomiting at 24 hours postoperatively. While the reduction in opioid use was not significantly correlated with the reduction in nausea and vomiting, these findings remain clinically significant for surgical patients.