Intraoperative ketamine for acute postoperative pain management in surgeries under general anesthesia, Hospital Vicente Corral Moscoso, Cuenca 2025
DOI:
https://doi.org/10.26871/ceus.v8i2.304Keywords:
ketamine, postoperative pain, analgesia, visual analog scale, general anesthesiaAbstract
Introduction: proper management of postoperative pain reduces chronic pain, prevents prolonged hospital
stays, and improves recovery. Ketamine as an adjunct to multimodal analgesia has shown promising
results for postoperative pain control.
Objective: to determine the differences between intraoperative ketamine and conventional analgesia for
the management of acute postoperative pain in surgeries performed under general anesthesia at Hospital
Vicente Corral Moscoso, Cuenca, 2025.
Methodology: an observational, analytical, longitudinal, and prospective study was conducted on 422
patients over 18 years of age. The group that received adjunctive ketamine was compared with the group
that received only conventional analgesia. Pain intensity was assessed using the Visual Analogue Scale
(VAS). Descriptive statistics were applied, and the Mann-Whitney U test was used.
Results: patients aged 20 to 39 years, female, urban residents, and those with a secondary education
predominated. Laparoscopy was the most frequent surgical method. The group that received ketamine plus
conventional analgesia experienced less intense pain at 2 and 12 hours postoperatively, a lower need for
rescue analgesia, and less use of opioids and NSAIDs. Adverse effects were more frequent in this group,
with vomiting and sialorrhea being the most common.
Conclusions: administering ketamine as an adjunct was associated with better postoperative pain control
and a lower need for rescue analgesia, but it had more side effects than conventional analgesia alone.
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References
[1] Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN 2020;161:1976. https://doi.org/10.1097/j.pain.0000000000001939.
[2] Martínez Y, Sadín MRR, Guerrero GC, et al. Analgesia preventiva con microdosis de ketamina en pacientes operados con anestesia general. Revista Chilena de Anestesia 2020;49. https://doi.org/10.25237/revchilanestv49n05-12.
[3] Pascual A, Martinez J. Dolor Agudo Postoperatorio. Curso online de Dolor, Editorial Médica Panamericana; 2019.
[4] Wang X, Lin C, Lan L, et al. Perioperative intravenous S-ketamine for acute postoperative pain in adults: A systematic review and meta-analysis. J Clin Anesth 2021;68:110071. https://doi.org/10.1016/j.jclinane.2020.110071.
[5] Aller SAN. Anestesia libre de opioides. Revisión de la técnica y aplicación en un caso de paciente adicto a opiáceos. AnestesiaR 2023. https://anestesiar.org/2023/anestesia-libre-de-opioides-revision/ (accessed April 18, 2026).
[6] Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med 2018;43:456–66. https://doi.org/10.1097/AAP.0000000000000806.
[7] Bujedo M. Ketamina intravenosa peroperatoria y para tratamiento del dolor crónico | SVNRARTD 2019. https://www.svnrartd.com/publicaciones-y-documentos/ketamina-intravenosa-peroperatoria-y-para-tratamiento-del-dolor-cronico (accessed April 18, 2026).
[8] Segura-Méndez B, Guerrero-Peral ÁL, Carrascal Y. Dolor en el postoperatorio de cirugía cardíaca: bases neurobiológicas y tratamiento. Rev Neurol 2022;75:149–57. https://doi.org/10.33588/rn.7506.2022194.
[9] Pérez MJ. Manejo del dolor en el postoperatorio. Revista Medica Sinergia 2023;8:e1101–e1101. https://doi.org/10.31434/rms.v8i9.1101.
[10] Nowacka A, Borczyk M. Ketamine applications beyond anesthesia – A literature review. European Journal of Pharmacology 2019;860:172547. https://doi.org/10.1016/j.ejphar.2019.172547.
[11] Torres SS, Carrillo-Torres O, Rascón-Martínez DM. Clínicas de ketamina: usos actuales según la evidencia. Rev Mex Anest 2023;46:197–203.
[12] Matos HM, García M. Uso de la ketamina endovenosa en anestesiología: revisión de la evidencia y mejores prácticas. Revista Chilena de Anestesia 2023;52. https://doi.org/10.25237/revchilanestv52n6-03.
[13] Monerris Tabasco M. Utilidad o necesidad de la ketamina en el dolor postoperatorio. Revista de La Sociedad Española Del Dolor 2021;28:63–6. https://doi.org/10.20986/resed.2021.3921/2021.
[14] Antolinez L. Escala visual análoga 2014.
[15] Miziara LE de PG, Simoni RF, Esteves LO, et al. Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial. Anesthesiology Research and Practice 2016;2016:6918327. https://doi.org/10.1155/2016/6918327.
[16] Ithnin FB, Tan DJA, Xu XL, et al. Low-dose S+ ketamine in target-controlled intravenous anaesthesia with remifentanil and propofol for open gynaecological surgery: A randomised controlled trial. Indian Journal of Anaesthesia 2019;63:126. https://doi.org/10.4103/ija.IJA_605_18.
[17] Brinck EC, Tiippana E, Heesen M, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev 2018;2018:CD012033. https://doi.org/10.1002/14651858.CD012033.pub4.
[18] Li Z, Chen Y. Ketamine reduces pain and opioid consumption after total knee arthroplasty: A meta-analysis of randomized controlled studies. International Journal of Surgery 2019;70:70–83. https://doi.org/10.1016/j.ijsu.2019.08.026.
[19] Sánchez MA. ¿Cómo puedo calcular el tamaño de la muestra? Importancia en la calidad y la validez en la investigación en ciencias de la salud. CyRS 2022;4:113–26. https://doi.org/10.22201/fesz.26831422e.2022.4.2.8.
[20] Abouarab AH, Brülle R, Aboukilila MY, et al. Efficacy and safety of perioperative ketamine for the prevention of chronic postsurgical pain: A meta-analysis. Pain Practice 2024;24:553–66. https://doi.org/10.1111/papr.13314.
[21] Zhang Y, Cui F, Ma J-H, et al. Mini-dose esketamine–dexmedetomidine combination to supplement analgesia for patients after scoliosis correction surgery: a double-blind randomised trial. British Journal of Anaesthesia 2023;131:385–96. https://doi.org/10.1016/j.bja.2023.05.001.
[22] Khalil BNM, Elderh MSH, Khaja MAR, et al. Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial. BMC Anesthesiol 2023;23:108. https://doi.org/10.1186/s12871-023-02059-3.
[23] Hall J, Chung J, Khilkin M, et al. Ketamine as part of multi-modal analgesia may reduce opioid requirements following cardiac surgery: a retrospective observational cohort study. J Cardiothorac Surg 2025;20:178. https://doi.org/10.1186/s13019-025-03405-x.
[24] Yang N, Peng L, Kuang R, et al. Effect of perioperative intravenous ketamine on postoperative sleep disturbance in patients undergoing non-cardiac surgery: A systematic review and meta-analysis. Indian J Anaesth 2025;69:434–49. https://doi.org/10.4103/ija.ija_75_25.
[25] Webb AR, Skinner BS, Leong S, et al. The Addition of a Small-Dose Ketamine Infusion to Tramadol for Postoperative Analgesia: A Double-Blinded, Placebo-Controlled, Randomized Trial After Abdominal Surgery. Anesthesia & Analgesia 2007;104:912. https://doi.org/10.1213/01.ane.0000256961.01813.da.
[26] Guo J, Qiu D, Gu H, et al. Efficacy and safety of perioperative application of ketamine on postoperative depression: A meta-analysis of randomized controlled studies. Mol Psychiatry 2023;28:2266–76. https://doi.org/10.1038/s41380-023-01945-z.
[27] Santana KS, García-Posada LD, Landeros-Navarro IY, et al. Analgesia postmastectomía con infiltración subcutánea en herida quirúrgica de ketamina con lidocaína. Revista Médica del Instituto Mexicano del Seguro Social 2023;61:S120-6.
[28] Xu M, Zhu R, She Y-J, et al. Perioperative Ketamine and Esketamine for Enhanced Recovery After Surgery (ERAS): A Systematic Review. Journal of Investigative Surgery 2026;39:2637241. https://doi.org/10.1080/08941939.2026.2637241.
[29] Meyer CH, Lipke E, Weibel S, et al. Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: A systematic review and meta-analysis. J Clin Anesth 2022;78:110652. https://doi.org/10.1016/j.jclinane.2022.110652.
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