Perioperative ketamine or esketamine for acute postoperative pain after laparoscopic cholecystectomy: A systematic review and meta-analysis with meta-regression
Authors' conclusion
With a very low level of certainty, this meta-analysis demonstrated that ketamine/esketamine might help reduce acute postoperative pain and postoperative opioid needs in patients undergoing LC.
Study context
- Population
- Patients undergoing laparoscopic cholecystectomy
- Participants
- 3,508 patients · 48 randomized controlled trials (RCTs)
- Comparison
- Perioperative ketamine/esketamine vs control
- Outcome
- Postoperative pain scores
Methodological detailsmeta-regression, subgroup analysis by regimen
- Meta-regression
- Subgroup analysis by regimen
Pooled result
As reported in the abstract
Postoperative pain
MD
−1.11
P = 0.044
at 4 h; I² = 97.8%; very low-certainty evidence
MD
−0.40
P = 0.019
at 6 h; I² = 86.1%; very low-certainty evidence
Further pooled results
| Outcome | Estimate | P value |
|---|---|---|
| 24-h opioid consumptionI² = 98.3%; very low-certainty evidence | MD −4.10 | P = 0.024 |
| Need for rescue analgesiaI² = 36%; very low-certainty evidence | RR 0.64 | P = 0.006 |
| Postoperative pain, esketamine (subgroup)Esketamine vs Control · at 1 h; I² = 0% | MD −0.67 | P = 0.034 |
| Postoperative pain, esketamine (subgroup)Esketamine vs Control · at 2 h; I² = 79.3% | MD −0.91 | P = 0.008 |
| 24-h opioid consumption and need for rescue analgesia, ketamine (subgroup)Ketamine vs Control · 24-h opioid consumption; I² = 96% | MD −5.35 | P = 0.01 |
| 24-h opioid consumption and need for rescue analgesia, ketamine (subgroup)Ketamine vs Control · need for rescue analgesia; I² = 41.7% | RR 0.64 | P = 0.011 |
Safety
Hallucinations, diplopia, nystagmus
- Significantly increased risk with ketamine/esketamine
Original publication
Perioperative ketamine or esketamine for acute postoperative pain after laparoscopic cholecystectomy: A systematic review and meta-analysis with meta-regression. Anaesth Crit Care Pain Med. Published 5 February 2026. doi:10.
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