Perioperative pain management is a fundamental aspect of anesthesia care. Immediate postoperative pain management is a challenging area with huge variability in pain influenced by the surgical procedure, preoperative use of opioids, preexisting disease, and many more factors. Especially orthopedic, gynecological, and thoracic operations prove to be highly painful. Postoperative pain results in complications including prolonged hospitalization, risk of pain chronification, and a higher rate of cardiovascular, pulmonary, and gastrointestinal complications. Despite the mounting evidence in favor of multimodal analgesia, the majority of drugs employed for postoperative pain management are opioids. Ketamine could therefore be a valuable adjunct for perioperative analgesia. We performed a narrative review of systematic reviews published between January 1, 1990, and February 29, 2024, on perioperative ketamine for postsurgical pain published in Embase (via Ovid), Ovid MEDLINE, and Cochrane Database of Systematic Reviews. The evidence on perioperative use of ketamine shows a relevant pain reduction extending beyond the immediate postoperative phase. Especially patients with high risk for severe, prolonged postoperative pain may benefit from perioperative ketamine. With vast dosing and application differences between studies, further research is required to find optimized use schedules.