Efficacy of intraoperative low dose intravenous Esketamine for acute postoperative pain control: Meta-analysis of randomized controlled trials
Authors' conclusion
Intraoperative low-dose esketamine modestly reduces postoperative pain at rest (4-48 h) and during movement (12-48 h), decreases opioid and rescue analgesia requirements, and slightly lowers propofol use.
Study context
- Population
- Patients undergoing surgery (acute postoperative pain)
- Participants
- 3,831 patients · 35 RCTs
- Comparison
- Intraoperative low-dose IV esketamine vs control
- Esketaminen = 2,168
- Controln = 1,663reference
- Outcome
- Acute postoperative pain
Methodological detailsleave-one-out sensitivity analysis, meta-regression
- Leave-one-out sensitivity analysis
- Meta-regression
Pooled result
As reported in the abstract
Pain at rest · 4, 12, 24, 48 h
- 4 h
- MD −1.40; P < 0.0001
- 12 h
- MD −0.84; P < 0.0001
- 24 h
- MD −0.54; P < 0.0001
- 48 h
- MD −0.39; P = 0.0014
Further pooled results
Pain on movement · 12 h
- Lower pain on movement at 12 h (MD; p = 0.0111)
- −0.62
Pain on movement · 24 h
- Lower pain on movement at 24 h (MD; p = 0.0003)
- −0.63
Pain on movement · 48 h
- Lower pain on movement at 48 h
- MD −0.40 (95% CI −0.74 to −0.06; p = 0.0212)
- I2 = 75.5%
Postoperative morphine consumption
- Reduced at 4, 24 and 48 h, with no significant difference at 12 h
Rescue analgesia requirements
- Rescue analgesia requirements reduced (RR; p = 0.0001)
- 0.52
Intraoperative propofol use
- Intraoperative propofol use modestly lower (mg; p = 0.0047)
- −18.47
Dose-response relationship
- No significant dose-response relationship identified (p)
- 0.0571
Safety
Overall and individual adverse events (nausea, agitation, dizziness, hallucinations)
- No significant differences between groups
Original publication
Efficacy of intraoperative low dose intravenous Esketamine for acute postoperative pain control: Meta-analysis of randomized controlled trials. J Clin Anesth. Published 23 July 2026. doi:10.
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