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Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies

Daphnée Michelet1,2, Julie Hilly1,2, Alia Skhiri1,2

  • 1Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.

Paediatric Drugs
|October 1, 2016
PubMed

Insights

This study found ketamine does not reduce opioid use in children after surgery. Trial sequential analysis confirmed a lack of evidence for ketamine

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Postoperative opioid consumption is a significant concern in pediatric recovery.
  • The efficacy of ketamine as an opioid-sparing agent in children remains debated.
  • Previous meta-analyses have yielded inconclusive results.

Purpose of the Study:

  • To update a previous meta-analysis on ketamine's opioid-sparing effect in pediatric patients.
  • To incorporate trial sequential analysis (TSA) for enhanced evidence evaluation.
  • To assess ketamine's impact on postoperative pain, nausea, vomiting, and psychotomimetic symptoms.

Main Methods:

  • A systematic literature search identified relevant clinical trials in children and infants.
  • Data from 11 articles (7 previous + 4 new) were meta-analyzed.
  • Trial sequential analysis (TSA) was performed to assess the robustness of findings.

Main Results:

  • Ketamine did not demonstrate a significant opioid-sparing effect up to 48 hours postoperatively.
  • No reduction in postoperative pain intensity was observed with ketamine use.
  • TSA indicated insufficient statistical power to conclude on the primary outcome (24-hour opioid consumption).
  • Ketamine did not increase the incidence of postoperative nausea, vomiting, or psychotomimetic symptoms.

Conclusions:

  • This updated meta-analysis found no evidence supporting ketamine's opioid-sparing effect in pediatric postoperative care.
  • The results suggest a potential lack of statistical power, necessitating further investigation.
  • Additional high-quality studies are required to definitively assess ketamine's role in reducing opioid consumption in children.
Abstract

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