The efficacy of ketamine supplementation on pain management for knee arthroscopy A meta-analysis of randomized controlled trials

Introduction: The efficacy of ketamine supplementation on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation for knee arthroscopy. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation on pain control for knee arthroscopy. This meta-analysis is performed using the random-effect model. Results: Seven RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation reveals favorable impact on pain scores (mean difference [MD]=-2.95; 95% confidence interval [CI]=-3.36 to -2.54; P<.00001), analgesic consumption (standard mean difference [Std. MD]=-1.03; 95% CI=-1.70 to -0.36; P=.002), time to first analgesic requirement (Std. MD=1.21; 95% CI=0.45-1.96; P=.002) and malondialdehyde (Std. MD=0.63; 95% CI=-1.05 to 3.10; P=-.20), and shows no increase in nausea and vomiting (RR=1.87; 95% CI=0.65-3.10; P=.003). Conclusions: Ketamine supplementation benefits to pain management and may reduce ischemia reperfusion injury in patients with knee arthroscopy.