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Pediatric Drugs
Published in: Pediatric Drugs 6/2016

01-12-2016 | Systematic Review

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

Authors: Daphnée Michelet, Julie Hilly, Alia Skhiri, Rachida Abdat, Thierno Diallo, Christopher Brasher, Souhayl Dahmani

Published in: Pediatric Drugs | Issue 6/2016

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Abstract

Introduction

Reducing postoperative opioid consumption is a priority given its impact upon recovery, and the efficacy of ketamine as an opioid-sparing agent in children is debated. The goal of this study was to update a previous meta-analysis on the postoperative opioid-sparing effect of ketamine, adding trial sequential analysis (TSA) and four new studies.

Materials and Methods

A comprehensive literature search was conducted to identify clinical trials that examined ketamine as a perioperative opioid-sparing agent in children and infants. Outcomes measured were postoperative opioid consumption to 48 h (primary outcome: postoperative opioid consumption to 24 h), postoperative pain intensity, postoperative nausea and vomiting and psychotomimetic symptoms. The data were combined to calculate the pooled mean difference, odds ratios or standard mean differences. In addition to this classical meta-analysis approach, a TSA was performed.

Results

Eleven articles were identified, with four added to seven from the previous meta-analysis. Ketamine did not exhibit a global postoperative opioid-sparing effect to 48 postoperative hours, nor did it decrease postoperative pain intensity. This result was confirmed using TSA, which found a lack of power to draw any conclusion regarding the primary outcome of this meta-analysis (postoperative opioid consumption to 24 h). Ketamine did not increase the prevalence of either postoperative nausea and vomiting or psychotomimetic complications.

Conclusions

This meta-analysis did not find a postoperative opioid-sparing effect of ketamine. According to the TSA, this negative result might involve a lack of power of this meta-analysis. Further studies are needed in order to assess the postoperative opioid-sparing effects of ketamine in children.
Footnotes
1
http://​www.​cochrane-handbook.​org/​ (Section 9.4.6). Last accessed June 2016.
 
2
http://​www.​cochrane-handbook.​org/​ (Section 9.5.2). Last accessed June 2016.
 
3
http://​www.​cochrane-handbook.​org/​ (Section 10.4.3.1). Last access June 2016.
 
4
http://​www.​cochrane-handbook.​org/​ (Section 10.4.3.1). Last access June 2016.
 
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Metadata
Title
Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies
Authors
Daphnée Michelet
Julie Hilly
Alia Skhiri
Rachida Abdat
Thierno Diallo
Christopher Brasher
Souhayl Dahmani
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 6/2016
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.1007/s40272-016-0196-y

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