Tolerability and efficacy profile of S-ketamine compared with racemic ketamine in surgical patients, a prospective observational before-and-after study in the perioperative setting

doi:10.1016/j.bjao.2026.100548

Anaesthetic drugs & techniques

Tolerability and efficacy profile of S-ketamine compared with racemic ketamine in surgical patients, a prospective observational before-and-after study in the perioperative setting

BJA OpenPublished 1 May 2026Prospective observational before-and-after study

Main finding · HallucinationsResultRisk difference 1.34% 95% CI −0.50 to 2.90

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Authors' conclusion

S-Ketamine demonstrated a safer profile compared with Ra-Ketamine, including fewer psychodysleptic side effects and possible superior analgesic efficacy

Study context

Population: Patients receiving ketamine during anaesthesia for any type of surgery, 4 APHP Sorbonne Universite hospitals, Paris, 19 February to 22 March 2024; persistent sedation after surgery excluded783 included
Participants: 447 vs 339

Exposure: Racemic ketamine vs S-ketamine
Ra-Ketaminen = 447reference
S-Ketaminen = 339
Outcome: Occurrence of hallucination, as a proxy for ketamine's tolerance

Methodological detailsmulticentre, before-after (institutional switch from Ra- to S-Ketamine)

Multicentre
Before-after (institutional switch from Ra- to S-Ketamine)

Main finding

Hallucinations

Risk difference

1.34%

95% CI −0.50 to 2.90

P = 0.04

By group

Ra-Ketamine1.4%

S-Ketamine0%

Ra-Ketamine vs S-Ketamine

risk difference 1.34% (95% CI −0.50 to 2.90); P = 0.04

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	Ra-Ketamine	S-Ketamine		Median difference (95% CI)	P value
Morphine dose in the PACU	10 (IQR 6–12) mg	8 (IQR 6–10) mg	−15−10−50510	1.00 (0.00–3.00)	P = 0.02
PACU LOS	105 (IQR 65–150) min	100 (IQR 70–153) min	−15−10−50510	−1.0 (−10.0 to 6.0)	P = 0.70
			−15−10−50510Difference (linear scale)

Infusion strategy

Similar in both groups

Original publication

Tolerability and efficacy profile of S-ketamine compared with racemic ketamine in surgical patients, a prospective observational before-and-after study in the perioperative setting. BJA Open. Published 1 May 2026. doi:10.1016/j.bjao.2026.100548

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