Intraoperative ketamine may reduce opioid consumption, pain, nausea, vomiting after TJA
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A systematic literature review found the use of intraoperative ketamine during total hip and knee arthroplasty may reduce postoperative opioid consumption, pain, nausea and vomiting; however, it should be used cautiously in older patients.
To assess the efficacy and safety of intraoperative IV ketamine for patients undergoing THA and TKA, Charles P. Hannon, MD, MBA, and colleagues used the MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases to analyze seven studies that were published before 2020 on the treatment in total joint arthroplasty.
Overall, four studies found intraoperative ketamine yielded better pain outcomes and three studies found no significant differences in pain outcomes compared with placebo. Of the six studies that analyzed postoperative opioid use, five studies found intraoperative ketamine decreased cumulative opioid consumption and one study found no significant differences vs. placebo.
Meta-analysis of the four studies that evaluated complications found intraoperative ketamine decreased postoperative nausea and vomiting compared with placebo. None of these studies found any other differences in complications between the ketamine cohort vs. the placebo group.
“Intraoperative intravenous ketamine reduces postoperative opioid consumption and may reduce postoperative pain and nausea and vomiting after primary TJA,” the researchers wrote in the study. “Ketamine administered intraoperatively is safe but may increase the risk of postoperative delirium and hallucinations, particularly among elderly patients after TJA,” they concluded.
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