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Ketamine for pain control in acute bone fractures: A systematic review and meta-analysis of randomized controlled
João Pedro Campos Lima1, Gabriel Vieira Piredda, Elias Victor Nogueira Balbino Lima
1From the Department of Research (J.P.C.L.), Hospital São Vicente de Paulo, Bom Jesus do Itabapoana, Brazil; Department of Medicine (J.P.C.L., G.V.P., K.A.C.), UniREDENTOR/Afya, Itaperuna, Brazil; Department of Medicine (E.V.N.B.L.), Universidade Iguaçu, Itaperuna, Brazil; and Department of Orthopedics and Traumatology Professor Nova Monteiro (V.G.), Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
Background:
This systematic review and meta-analysis evaluated the efficacy and safety of ketamine for pain management in acute bone fractures, assessing pain intensity, additional analgesia needs, hospital stay, patient satisfaction, and adverse events.
Methods:
A systematic search of PubMed, Cochrane, and Embase databases was conducted up to July 2025, identifying randomized controlled trials involving adult patients with acute bone fractures. Studies comparing ketamine (monotherapy or adjuvant) against placebo, standard care, or alternative pain management were included. Data extraction and risk of bias assessment were performed independently by two reviewers. Meta-analyses used random-effects models, with continuous outcomes analyzed via mean differences and standardized mean differences, and dichotomous outcomes via risk ratios.
Results:
Fourteen randomized controlled trials, encompassing 1,453 patients, were included. No statistically significant differences in pain intensity were found between ketamine and control groups at 15, 30, or 60 minutes (p>0.05). Similarly, no significant differences were observed in additional analgesia requirements, hospital length of stay, or patient satisfaction (p>0.05). While overall adverse events were comparable, ketamine was associated with increased rates of nervous system (48% vs 16%) and psychiatric (14,6% vs 4%) adverse events. Sensitivity analysis, excluding high-risk bias studies, suggested a trend toward improved ketamine efficacy at 15 minutes (SMD -1.24; 95% CI -2.72, 0.24; p=0.10) and significant improvement at 30 minutes (SMD -0.43; 95% CI -0.12, 0.75; p=0.007).
Conclusion:
Ketamine for acute bone fractures shows minimal to no difference in pain management compared with conventional approaches. However, a trend toward reduced additional analgesia, including opioid consumption, was noted. The increased incidence of nervous system and psychiatric adverse events with ketamine necessitates strict medical monitoring.
Level Of Evidence:
Systematic Review and Meta-analysis; Level III.
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