Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China.
Pain Physician. 2023 Jul;26(4):327-335.
S-ketamine is the S-enantiomer of ketamine, which exerts anesthetic and analgesic effects through noncompetitive antagonism of N-methyl-D-aspartate (NMDA) receptors.
We aimed to define the relative risk of post-abdominal surgery pain in adults who were administered perioperative S-ketamine.
Systematic review and meta-analysis.
Two reviewers independently screened the articles from the titles and abstracts based on our eligibility criteria, evaluated the risk of bias by using the Cochrane Collaboration Risk of Bias tool in randomized controlled trials, and extracted the data from the included studies according to a prespecified protocol; any disagreements were solved by consultation. The level of certainty for the main results were evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
Of the 1,621 studies identified, 9 studies were included; they were published from 2004 through 2022. Only one study involved epidural anesthesia, whereas the other 8 studies included general anesthesia. The pain at rest scores at 4 and 24 hours post-abdominal surgery were significantly lower in the S-ketamine group, respectively. However, there was no significant difference between the 2 groups in the pain at rest scores at 48 hours post-abdominal surgery. S-ketamine infusion reduced pain during movement 24 hours post-abdominal surgery, but not at 48 hours, respectively. The incidence of postoperative nausea and vomiting, as well as psychotomimetic adverse effects post-abdominal surgery were similar between the 2 groups, respectively. A subgroup analysis revealed that the pain at rest score at 4 hours post-abdominal surgery in patients in the intraoperative use group was remarkably reduced, compared with the patients who received S-ketamine perioperatively. Otherwise, the pain at rest score at 24 hours post-abdominal surgery in the perioperative use group was significantly reduced versus intraoperative use group.
The number of trials included was small. The remarkable heterogeneity found in the pooled results at each time point post-abdominal surgery might affect the credibility of the results.
S-ketamine is effective in reducing the early postoperative pain of patients who received abdominal surgery, and may not increase the incidence of postoperative complications.
S-氯胺酮是氯胺酮的 S-对映体，通过非竞争性拮抗 N-甲基-D-天冬氨酸（NMDA）受体发挥麻醉和镇痛作用。
本研究旨在确定围手术期给予 S-氯胺酮的成年人术后腹部疼痛的相对风险。
系统评价和荟萃分析。
两位审查员根据纳入标准，分别从标题和摘要中筛选文章，使用 Cochrane 协作风险偏倚工具评估随机对照试验的风险偏倚，并根据预设方案从纳入的研究中提取数据；任何分歧均通过协商解决。根据推荐评估、制定与评估（GRADE）系统对主要结果的确定性水平进行评估。
在 1621 项研究中，有 9 项研究符合纳入标准，这些研究发表于 2004 年至 2022 年。只有 1 项研究涉及硬膜外麻醉，而其余 8 项研究则包括全身麻醉。术后 4 小时和 24 小时静息时疼痛评分，S-氯胺酮组明显较低。然而，术后 48 小时两组静息时疼痛评分无显著差异。S-氯胺酮输注分别降低术后 24 小时运动时疼痛和 48 小时运动时疼痛。两组术后恶心呕吐发生率以及术后腹部手术幻觉样不良反应发生率相似。亚组分析显示，术中使用组术后 4 小时静息时疼痛评分明显降低，而围手术期使用组术后 24 小时静息时疼痛评分明显降低。
纳入的试验数量较少。每个术后时间点的汇总结果中发现的显著异质性可能会影响结果的可信度。
S-氯胺酮可有效减轻接受腹部手术患者的术后早期疼痛，且可能不会增加术后并发症的发生率。
