Bell R F, Dahl J B, Moore R A, Kalso E
Pain Clinic, Department of Anaesthesia and Intensive Care, Haukeland University Hospital and Department of Surgical Sciences, University of Bergen, Norway.
Acta Anaesthesiol Scand. 2005 Nov;49(10):1405-28. doi: 10.1111/j.1399-6576.2005.00814.x.
Post-operative pain management is usually limited by adverse effects such as nausea and vomiting. Adjuvant treatment with an inexpensive opioid-sparing drug such as ketamine may be of value in giving better analgesia with fewer adverse effects. The objective of this systematic review was to evaluate the effectiveness and tolerability of ketamine administered peri-operatively in the treatment of acute post-operative pain in adults.
Studies were identified from MEDLINE (1966-2004), EMBASE (1980-2004), the Cochrane Library (2004) and by hand searching reference lists from review articles and trials. The manufacturer of ketamine (Pfizer AS, Lysaker, Norway) provided search results from their in-house database, PARDLARS. Randomized and controlled trials (RCTs) of adult patients undergoing surgery, being treated with peri-operative ketamine, placebo or an active control were considered for inclusion.
Eighteen trials were excluded. Thirty-seven trials were included. Twenty-seven out of 37 trials found that peri-operative ketamine reduced rescue analgesic requirements or pain intensity, or both. Quantitative analysis showed that treatment with ketamine reduced 24-h patient-controlled analgesia (PCA) morphine consumption and post-operative nausea and vomiting (PONV). Adverse effects were mild or absent.
In the first 24 h after surgery, ketamine reduces morphine requirements. Ketamine also reduces PONV. Adverse effects are mild or absent. These data should be interpreted with caution as the retrieved studies were heterogenous and the result of the meta-analysis can not be translated into any specific administration regimen with ketamine.
术后疼痛管理通常受到恶心和呕吐等不良反应的限制。使用氯胺酮等廉价的阿片类药物节省剂进行辅助治疗，可能有助于在减少不良反应的情况下提供更好的镇痛效果。本系统评价的目的是评估围手术期给予氯胺酮治疗成人急性术后疼痛的有效性和耐受性。
从MEDLINE（1966 - 2004年）、EMBASE（1980 - 2004年）、Cochrane图书馆（2004年）以及通过手工检索综述文章和试验的参考文献列表中识别研究。氯胺酮制造商（挪威利萨克市辉瑞公司）提供了其内部数据库PARDLARS的检索结果。纳入接受手术的成年患者，接受围手术期氯胺酮、安慰剂或活性对照治疗的随机对照试验（RCT）。
排除18项试验。纳入37项试验。37项试验中的27项发现围手术期氯胺酮降低了补救性镇痛需求或疼痛强度，或两者均降低。定量分析表明，氯胺酮治疗减少了24小时患者自控镇痛（PCA）吗啡消耗量以及术后恶心和呕吐（PONV）。不良反应轻微或无。
在术后的最初24小时内，氯胺酮可降低吗啡需求量。氯胺酮还可减少PONV。不良反应轻微或无。由于检索到的研究具有异质性，且荟萃分析结果不能转化为氯胺酮的任何具体给药方案，因此应谨慎解读这些数据。
