2025, Vol. 7, Issue 2, Part F
Ketamine for perioperative pain and opioid sparing: A scoping review
Author(s): Ali Mansuor Mohammad Yasin
Abstract: Purpose: The purpose of this scoping review was to examine and map existing evidence on the effectiveness, dosing strategies, and safety of low dose ketamine for perioperative pain management and opioid reduction in adult surgical populations, and to identify gaps that require further investigation.
Methodology: The review followed the PRISMA Scoping Review framework. A comprehensive search of MEDLINE, Embase, and Cochrane CENTRAL was conducted through November 2025 to identify randomized controlled trials, observational cohorts, and systematic reviews evaluating perioperative ketamine administered intravenously, neuraxially, or via local infiltration. Eligible studies reported postoperative pain scores, opioid consumption, adverse effects, or recovery outcomes. Data were synthesized to characterise dosing patterns, clinical effects, and safety profiles.
Findings: Forty three studies met inclusion criteria, comprising twenty nine randomized controlled trials, eight cohort studies, and six systematic reviews. Across surgical procedures, ketamine consistently reduced twenty four hour opioid consumption by approximately twenty five to forty five percent and decreased postoperative pain scores by one to two points on a ten point scale. Psychotomimetic effects occurred in three to eight percent of patients but were transient and self resolving. Cardiovascular instability was not increased. Dosing commonly involved a bolus of 0.1 to 0.5 mg/kg followed by an infusion of 0.05 to 0.25 mg/kg per hour. Opioid tolerant patients and individuals undergoing spine surgery demonstrated the greatest benefit.
Unique Contribution to Theory, Policy and Practice: This review clarifies the mechanistic and clinical rationale for incorporating low dose ketamine within multimodal perioperative analgesia by consolidating evidence that supports NMDA receptor modulation as an effective strategy for mitigating opioid related burden. Findings support policy development toward standardised ketamine dosing protocols within Enhanced Recovery pathways and highlight its value for opioid stewardship initiatives. The review also identifies gaps in long term outcome reporting, offering a theoretical and practical foundation for future clinical trials aimed at optimising perioperative ketamine use and guiding evidence based anesthesia practice.
DOI: 10.22271/27081494.2025.v7.i2f.243Pages: 368-376 | Views: 239 | Downloads: 98Download Full Article: Click Here
How to cite this article:
Ali Mansuor Mohammad Yasin.
Ketamine for perioperative pain and opioid sparing: A scoping review. Int J Case Rep Surg 2025;7(2):368-376. DOI:
10.22271/27081494.2025.v7.i2f.243
