The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review

The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review

Introduction Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method We performed a quantitative systematic review. We included randomized controll...

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Veröffentlicht in:Pain practice 2021-03, Vol.21 (3), p.316-332
Hauptverfasser: Bi, Yaodan, Ye, Yu, Zhu, Yinchao, Ma, Jun, Zhang, Xiuqian, Liu, Bin
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breast surgery
ketamine
mastectomy
postmastectomy pain syndrome
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Ye, Yu
Zhu, Yinchao
Ma, Jun
Zhang, Xiuqian
Liu, Bin
description Introduction Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. Results Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P 
doi_str_mv 10.1111/papr.12961
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The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. Results Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P &lt; 0.001), and in decreasing opioid consumption (WMD −4.14; 95% CI −8.00, −0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD −0.59; 95% CI, −1.06, −0.12; P = 0.014) and during the first 24 hours after surgery (WMD −0.90; 95% CI −1.27, −0.53; P &lt; 0.001), and in decreasing opioid consumption (WMD − 4.59; 95% CI −5.76, −3.42; P &lt; 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference −0.80; 95% CI − 1.34, −0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043). Conclusion Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long‐term benefit for preventing postoperative depression and postmastectomy pain syndrome.</description><identifier>ISSN: 1530-7085</identifier><identifier>EISSN: 1533-2500</identifier><identifier>DOI: 10.1111/papr.12961</identifier><identifier>PMID: 33150677</identifier><language>eng</language><publisher>United States</publisher><subject>breast surgery ; ketamine ; mastectomy ; postmastectomy pain syndrome</subject><ispartof>Pain practice, 2021-03, Vol.21 (3), p.316-332</ispartof><rights>2020 World Institute of Pain</rights><rights>2020 World Institute of Pain.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3291-aea905e7ad63a8259c7583d182776c241750eb546643a5943f3171cfda669c943</citedby><cites>FETCH-LOGICAL-c3291-aea905e7ad63a8259c7583d182776c241750eb546643a5943f3171cfda669c943</cites><orcidid>0000-0001-5503-0053</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpapr.12961$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpapr.12961$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33150677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bi, Yaodan</creatorcontrib><creatorcontrib>Ye, Yu</creatorcontrib><creatorcontrib>Zhu, Yinchao</creatorcontrib><creatorcontrib>Ma, Jun</creatorcontrib><creatorcontrib>Zhang, Xiuqian</creatorcontrib><creatorcontrib>Liu, Bin</creatorcontrib><title>The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review</title><title>Pain practice</title><addtitle>Pain Pract</addtitle><description>Introduction Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. Results Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P &lt; 0.001), and in decreasing opioid consumption (WMD −4.14; 95% CI −8.00, −0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD −0.59; 95% CI, −1.06, −0.12; P = 0.014) and during the first 24 hours after surgery (WMD −0.90; 95% CI −1.27, −0.53; P &lt; 0.001), and in decreasing opioid consumption (WMD − 4.59; 95% CI −5.76, −3.42; P &lt; 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference −0.80; 95% CI − 1.34, −0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043). Conclusion Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long‐term benefit for preventing postoperative depression and postmastectomy pain syndrome.</description><subject>breast surgery</subject><subject>ketamine</subject><subject>mastectomy</subject><subject>postmastectomy pain syndrome</subject><issn>1530-7085</issn><issn>1533-2500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kMtOwzAQRS0EgvLY8AHIS4SUYsex3bALVXkIEBUPsYyMM2mNEqfYCVV2bNjzjXwJaQssGY00M9KZs7gI7VPSp10dz9TM9WkYC7qGepQzFoSckPXlTgJJBnwLbXv_QgiVMWObaIsxyomQsoc-HqaAR3kOusZVjq-gVqWxgCuLE93UgJXN8HDqKms0fqqa7horY3HXY1UbsLXHjzYDN6mMneBTB8rX-L5xE3DtCU7wTWf8ev9MrCpab_zSd9_6GsruXeM7eDMw30UbuSo87P3MHfR4NnoYXgTXt-eXw-Q60CyMaaBAxYSDVJlgahDyWEs-YBkdhFIKHUZUcgLPPBIiYorHEcsZlVTnmRIi1t29gw5X3pmrXhvwdVoar6EolIWq8WkYcRkLycUCPVqh2lXeO8jTmTOlcm1KSbqIPV3Eni5j7-CDH2_zXEL2h_7m3AF0BcxNAe0_qnScjO9W0m_cSI2i</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Bi, Yaodan</creator><creator>Ye, Yu</creator><creator>Zhu, Yinchao</creator><creator>Ma, Jun</creator><creator>Zhang, Xiuqian</creator><creator>Liu, Bin</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5503-0053</orcidid></search><sort><creationdate>202103</creationdate><title>The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review</title><author>Bi, Yaodan ; Ye, Yu ; Zhu, Yinchao ; Ma, Jun ; Zhang, Xiuqian ; Liu, Bin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3291-aea905e7ad63a8259c7583d182776c241750eb546643a5943f3171cfda669c943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>breast surgery</topic><topic>ketamine</topic><topic>mastectomy</topic><topic>postmastectomy pain syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bi, Yaodan</creatorcontrib><creatorcontrib>Ye, Yu</creatorcontrib><creatorcontrib>Zhu, Yinchao</creatorcontrib><creatorcontrib>Ma, Jun</creatorcontrib><creatorcontrib>Zhang, Xiuqian</creatorcontrib><creatorcontrib>Liu, Bin</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pain practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bi, Yaodan</au><au>Ye, Yu</au><au>Zhu, Yinchao</au><au>Ma, Jun</au><au>Zhang, Xiuqian</au><au>Liu, Bin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review</atitle><jtitle>Pain practice</jtitle><addtitle>Pain Pract</addtitle><date>2021-03</date><risdate>2021</risdate><volume>21</volume><issue>3</issue><spage>316</spage><epage>332</epage><pages>316-332</pages><issn>1530-7085</issn><eissn>1533-2500</eissn><abstract>Introduction Perioperative use of ketamine has been discussed widely in many kinds of surgery. The aim of our study was to evaluate the short‐term and long‐term benefits and safety of ketamine after breast surgery. Method We performed a quantitative systematic review. We included randomized controlled trials that compared intravenous administration of ketamine to a placebo control group, or compared bupivacaine in combination with ketamine to bupivacaine alone in thoracic paravertebral blocks or pectoral blocks among patients undergoing breast surgery. The primary outcome was postoperative pain intensity. Secondary outcomes included cumulative opioid consumption during the 0‐ to 24‐hour postoperative period, the effect on postmastectomy pain syndrome, the effect on postoperative depression, and the adverse events associated with the use of ketamine. Results Thirteen randomized controlled trials with 1,182 patients were included for analysis. Compared with placebo, intravenous ketamine was effective in reducing wound pain intensity during the first 6 hours after surgery (weighted mean difference [WMD] −0.83; 95% confidence interval [CI] −1.65, −0.01; P = 0.048) and during the first 24 hours after surgery (WMD −0.65; 95% CI −0.95, −0.35; P &lt; 0.001), and in decreasing opioid consumption (WMD −4.14; 95% CI −8.00, −0.29; P = 0.035) during the first 24 hours after surgery, without increasing the risks for gastrointestinal and central nervous system adverse events. Adding ketamine to bupivacaine in thoracic paravertebral blocks was also effective in reducing postoperative wound pain during the first 6 hours after surgery (WMD −0.59; 95% CI, −1.06, −0.12; P = 0.014) and during the first 24 hours after surgery (WMD −0.90; 95% CI −1.27, −0.53; P &lt; 0.001), and in decreasing opioid consumption (WMD − 4.59; 95% CI −5.76, −3.42; P &lt; 0.001) during the first 24 hours after surgery. Perioperative use of ketamine was associated with improved postoperative depression symptoms (standardized mean difference −0.80; 95% CI − 1.34, −0.27; P = 0.003) and less incidence of postmastectomy pain syndrome (relative risk 0.79; 95% CI 0.63, 0.99; P = 0.043). Conclusion Ketamine is an effective and safe multimodal analgesic in patients undergoing breast surgery, administered both intravenously and when added to bupivacaine in paravertebral blocks. In addition, ketamine showed a long‐term benefit for preventing postoperative depression and postmastectomy pain syndrome.</abstract><cop>United States</cop><pmid>33150677</pmid><doi>10.1111/papr.12961</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0001-5503-0053</orcidid></addata></record>
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subjects breast surgery
ketamine
mastectomy
postmastectomy pain syndrome
title The Effect of Ketamine on Acute and Chronic Wound Pain in Patients Undergoing Breast Surgery: A Meta‐Analysis and Systematic Review
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