Does Ketamine Reduce Postoperative Pain and Agitation in Septorhinoplasty? A Systematic Review and Meta-analysis

Abstract Background: Agitation and pain following rhino plastic surgery lead to complications that delay recovery and affect patients quality of life. Ketamine is established drug in anaesthesia induction and analgesic agent. It is investigated for the prevention of agitation in children yet it is recently investigated for the prevention of post-operative agitation in adults following rhinoplasty. We conducted this systematic review and meta-analysis of randomised controlled trials to summarise and conclude its role in sub anaesthetic dose for the prevention of agitation and pain relief. Methods: In our research, we explored four digital platforms (Cochrane Central Register of Controlled Trials, PubMed, Scopus and Web of Science) until April 2024, searching for relevant articles that assessed the efficacy of ketamine in managing post-operative pain and agitation. The quality of the trials was evaluated using the risk of bias 2 tool. The data from the selected studies were extracted into a standardised online form and analysed with RevMan 5.4. Results: This study included six studies with a total sample size of 558 patients. We included randomised clinical trials assessing the efficacy of ketamine for pain and agitation management after rhinoplasty, septoplasty, or rhinoseptoplasty. All included studies were of high quality. Results of meta-analysis showed statistically significant reduction in pain score and incidence of agitation post-operative (standardised mean difference = −0.85, 95% confidence interval [CI] [ − 1.26, −0.43], P < 0.0001), (risk ratio = 0.22, 95% CI [0.06, 0.78], P = 0.02), respectively. In addition, meta-analysis showed reduced analgesic requirements after surgery and treatment with ketamine was associated with less risk of nausea and vomiting. Conclusion: This systematic review and meta-analysis highlights ketamine’s potential benefits in post-surgery pain management and agitation reduction but emphasises the need for additional research with diverse and consistent samples to confirm these findings and examine possible side effects such as post-operative nausea and vomiting due to the observed heterogeneity amongst studies.