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<p>Ketamine, an NMDA receptor antagonist, is increasingly investigated for its analgesic and opioid-sparing effects in multimodal pain management. Bariatric surgery poses unique challenges due to obesity-related risks and opioid sensitivity. This meta-analysis evaluates ketamine's efficacy and safety in reducing postoperative pain and opioid consumption in this high-risk patient population. We searched PubMed, Scopus, the Web of Science, and the Cochrane library for randomized controlled trials using tailored search strategies up to 2025. Eligibility was based on the PICO framework, focusing on bariatric surgery patients receiving ketamine versus placebo, with primary outcomes of opioid consumption and VAS pain scores. The study included 12 randomized controlled trials with 1,019 patients. Ketamine significantly reduced total opioid consumption within 24 hours (MD -5.87; 95% CI [-10.37, -1.38], p = 0.01) and VAS pain scores at 4 hours (MD -0.81; 95% CI [-1.52, -0.10], p = 0.03). Postoperative adverse events were significantly lower (OR 0.42; 95% CI [0.29, 0.62], p &lt; 0.01), while no significant differences were observed for the duration of anesthesia, length of stay, estuation time, postoperative nausea and vomiting, or hemodynamic parameters. Sensitivity analyses confirmed result consistency. In summary, ketamine shows potential as an adjunct to multimodal analgesia in bariatric surgery, with reductions in opioid use and early postoperative pain observed across included studies. Although the limited number of trials and heterogeneity in study designs, these findings should be considered hypothesis-generating, and Low-dose ketamine should be considered as an adjunct for bariatric analgesia, particularly within ERAS protocols, but caution is necessary in patients prone to psychomimetic side effects.</p>

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Evaluating the Role of Ketamine in Multimodal Analgesia for Postoperative Pain Management in Bariatric Surgery: A Meta-Analysis of Randomized Controlled Trials

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Mohamed Wagdy,
  • Mohamed Abdo Khalafallah,
  • Hussein Kadhim Hussein,
  • Hiba Jasim Hafedh,
  • Rawaa M. Mohammed,
  • Asma Alshanqiti,
  • Alaa Hamza Hermis,
  • A’sem Mohammad Abedalqader Qannas,
  • Youssef Heikal

摘要

Ketamine, an NMDA receptor antagonist, is increasingly investigated for its analgesic and opioid-sparing effects in multimodal pain management. Bariatric surgery poses unique challenges due to obesity-related risks and opioid sensitivity. This meta-analysis evaluates ketamine's efficacy and safety in reducing postoperative pain and opioid consumption in this high-risk patient population. We searched PubMed, Scopus, the Web of Science, and the Cochrane library for randomized controlled trials using tailored search strategies up to 2025. Eligibility was based on the PICO framework, focusing on bariatric surgery patients receiving ketamine versus placebo, with primary outcomes of opioid consumption and VAS pain scores. The study included 12 randomized controlled trials with 1,019 patients. Ketamine significantly reduced total opioid consumption within 24 hours (MD -5.87; 95% CI [-10.37, -1.38], p = 0.01) and VAS pain scores at 4 hours (MD -0.81; 95% CI [-1.52, -0.10], p = 0.03). Postoperative adverse events were significantly lower (OR 0.42; 95% CI [0.29, 0.62], p < 0.01), while no significant differences were observed for the duration of anesthesia, length of stay, estuation time, postoperative nausea and vomiting, or hemodynamic parameters. Sensitivity analyses confirmed result consistency. In summary, ketamine shows potential as an adjunct to multimodal analgesia in bariatric surgery, with reductions in opioid use and early postoperative pain observed across included studies. Although the limited number of trials and heterogeneity in study designs, these findings should be considered hypothesis-generating, and Low-dose ketamine should be considered as an adjunct for bariatric analgesia, particularly within ERAS protocols, but caution is necessary in patients prone to psychomimetic side effects.