Jouguelet-Lacoste Julie, La Colla Luca, Schilling Dennis, Chelly Jacques E
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Pain Med. 2015 Feb;16(2):383-403. doi: 10.1111/pme.12619. Epub 2014 Dec 19.
As an analgesic and N-methyl-D-aspartate receptor antagonist, ketamine has been increasingly used as an adjunct in the management of acute perioperative pain. Although several meta-analyses have examined low-dose intravenous (i.v.) ketamine, they do not distinguish between different types of infusions. Additionally, the many clinical trials published on ketamine vary by regimen of administration and surgical site. This review seeks to exclusively examine the evidence supporting the use of low-dose i.v. infusion of ketamine for the management of perioperative pain.
We searched Medline for any clinical trials or meta-analyses that were conducted on low-dose i.v. infusion of ketamine between 1966 and November 2013. Using six equations, we were left with 695 references. Of those, five meta-analyses and 39 clinical trials met the criteria to be included our review. These clinical trials represent 2,482 patients, 1,403 of whom received ketamine. We then examined the efficacy of low-dose i.v. ketamine by regimen and site of surgery using pain scores and opioid consumption as endpoints. Finally, we assessed the safety and long-term impact of low-dose ketamine.
Low-dose i.v. ketamine reduces opioid consumption by 40%. It also lowers pain scores, but these findings are less clear. No major complications have been reported with low-dose i.v. infusion of ketamine when given up to 48 hours after surgery. While our review lends support to using low-dose i.v. infusion of ketamine in the management of perioperative pain, its optimal dose and regimen remain to be determined.
Thirty-nine clinical trials assessed a continuous infusion or a bolus of low-dose ketamine for postoperative analgesia using reduction of pain scores or reduction of the opioid consumption as the primary endpoint. The mean reduction of opioid consumption when using low-dose i.v. infusion ketamine (infusion rate less than 1.2 mg/kg/h) is 40%. Ketamine also reduces pain scores, but the amplitude of the effect is less clear. No major complications have been reported with low-dose i.v. infusion of ketamine up to 48 hours following surgery.
作为一种镇痛药和N-甲基-D-天冬氨酸受体拮抗剂，氯胺酮越来越多地被用作围手术期急性疼痛管理的辅助药物。尽管有几项荟萃分析研究了低剂量静脉注射氯胺酮，但它们并未区分不同类型的输注方式。此外，已发表的关于氯胺酮的众多临床试验在给药方案和手术部位方面存在差异。本综述旨在专门研究支持使用低剂量静脉输注氯胺酮来管理围手术期疼痛的证据。
我们在Medline中检索了1966年至2013年11月期间进行的关于低剂量静脉输注氯胺酮的任何临床试验或荟萃分析。通过六个公式，我们筛选出了６９５篇参考文献。其中，五项荟萃分析和39项临床试验符合纳入本综述的标准。这些临床试验涉及2482名患者，其中1403名接受了氯胺酮治疗。然后，我们以疼痛评分和阿片类药物消耗量为终点，按给药方案和手术部位研究了低剂量静脉注射氯胺酮的疗效。最后，我们评估了低剂量氯胺酮的安全性和长期影响。
低剂量静脉注射氯胺酮可使阿片类药物消耗量减少40%。它还能降低疼痛评分，但这些结果不太明确。在术后48小时内进行低剂量静脉输注氯胺酮时，未报告重大并发症。虽然我们的综述支持在围手术期疼痛管理中使用低剂量静脉输注氯胺酮，但其最佳剂量和给药方案仍有待确定。
39项临床试验评估了持续输注或推注低剂量氯胺酮用于术后镇痛，以疼痛评分降低或阿片类药物消耗量减少作为主要终点。使用低剂量静脉输注氯胺酮（输注速率小于1.2mg/kg/h）时，阿片类药物消耗量的平均减少幅度为40%。氯胺酮也能降低疼痛评分，但效果幅度不太明确。在术后48小时内进行低剂量静脉输注氯胺酮时，未报告重大并发症。
