According to a meta-analysis published in Pediatric Drugs, ketamine was not associated with a postoperative opioid-sparing effect. 

The efficacy of ketamine as an opioid-sparing drug in pediatric patients has been unclear. A team of researchers aimed to update a previously published meta-analysis on the postoperative opioid-sparing effect of ketamine with additional data from 4 new studies and a trial sequential analysis.

They conducted a literature search to identify clinical trials that evaluated ketamine as a perioperative opioid-sparing agent in children and infants. The primary study outcome was postoperative opioid consumption to 24 hours; other outcomes included postoperative opioid consumption to 48 hours, postoperative pain intensity/nausea/vomiting, and psychotomimetic symptoms. 

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A total of 11 articles were identified for review. The analysis showed that ketamine did not demonstrate a global postoperative opioid-sparing effect to 48 postoperative hours and did not reduce postoperative pain intensity. This finding was confirmed using a trial sequential analysis, “which found a lack of power to draw any conclusion regarding the primary outcome of this meta-analysis (postoperative opioid consumption to 24 hours).” 

Ketamine, however, did not increase the incidence of either postoperative nausea and vomiting or psychotomimetic complications, the authors reported. More studies are warranted to assess the postoperative opioid-sparing effects of ketamine in children.

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