1. 2020;23;135-148Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis
   Meta-Analysis
   Jianwei Wang, MS, Zifeng Xu, MD, Zhou Feng, MS, Rui Ma, BS, and Xiaoyu Zhang, MS.

BACKGROUND: The pain control effect of ketamine versus control in women during cesarean operation is not well determined.

OBJECTIVES: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia.

STUDY DESIGN: We used meta-analysis to address this concern.

SETTING: Meta-analysis-based study.

METHODS: The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software.

RESULTS: A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001).

LIMITATIONS: Limited patients were included with moderate strength.

CONCLUSIONS: Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia.

KEY WORDS: Ketamine, cesarean section, randomized controlled trials, meta-analysis