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Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies.

Identifieur interne : 001954 ( PubMed/Checkpoint ); précédent : 001953; suivant : 001955

Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies.

Auteurs : Daphnée Michelet [France] ; Julie Hilly [France] ; Alia Skhiri [France] ; Rachida Abdat [France] ; Thierno Diallo [France] ; Christopher Brasher [Australie] ; Souhayl Dahmani [France]

Source :

RBID : pubmed:27688125

Descripteurs français

English descriptors

Abstract

Reducing postoperative opioid consumption is a priority given its impact upon recovery, and the efficacy of ketamine as an opioid-sparing agent in children is debated. The goal of this study was to update a previous meta-analysis on the postoperative opioid-sparing effect of ketamine, adding trial sequential analysis (TSA) and four new studies.

DOI: 10.1007/s40272-016-0196-y
PubMed: 27688125


Affiliations:


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pubmed:27688125

Le document en format XML

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<name sortKey="Brasher, Christopher" sort="Brasher, Christopher" uniqKey="Brasher C" first="Christopher" last="Brasher">Christopher Brasher</name>
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<name sortKey="Dahmani, Souhayl" sort="Dahmani, Souhayl" uniqKey="Dahmani S" first="Souhayl" last="Dahmani">Souhayl Dahmani</name>
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<title level="j">Paediatric drugs</title>
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<term>Analgesics, Opioid (therapeutic use)</term>
<term>Child</term>
<term>Humans</term>
<term>Ketamine (therapeutic use)</term>
<term>Pain, Postoperative (drug therapy)</term>
<term>Postoperative Nausea and Vomiting (epidemiology)</term>
</keywords>
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<term>Analgésiques morphiniques (usage thérapeutique)</term>
<term>Douleur postopératoire (traitement médicamenteux)</term>
<term>Enfant</term>
<term>Humains</term>
<term>Kétamine (usage thérapeutique)</term>
<term>Vomissements et nausées postopératoires (épidémiologie)</term>
</keywords>
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<term>Analgesics, Opioid</term>
<term>Ketamine</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en">
<term>Pain, Postoperative</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en">
<term>Postoperative Nausea and Vomiting</term>
</keywords>
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<term>Douleur postopératoire</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr">
<term>Analgésiques morphiniques</term>
<term>Kétamine</term>
</keywords>
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<term>Vomissements et nausées postopératoires</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Child</term>
<term>Humans</term>
</keywords>
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<term>Enfant</term>
<term>Humains</term>
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<div type="abstract" xml:lang="en">Reducing postoperative opioid consumption is a priority given its impact upon recovery, and the efficacy of ketamine as an opioid-sparing agent in children is debated. The goal of this study was to update a previous meta-analysis on the postoperative opioid-sparing effect of ketamine, adding trial sequential analysis (TSA) and four new studies.</div>
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<DateCreated>
<Year>2016</Year>
<Month>09</Month>
<Day>30</Day>
</DateCreated>
<DateCompleted>
<Year>2016</Year>
<Month>12</Month>
<Day>13</Day>
</DateCompleted>
<DateRevised>
<Year>2017</Year>
<Month>11</Month>
<Day>14</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">1179-2019</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>18</Volume>
<Issue>6</Issue>
<PubDate>
<Year>2016</Year>
<Month>Dec</Month>
</PubDate>
</JournalIssue>
<Title>Paediatric drugs</Title>
<ISOAbbreviation>Paediatr Drugs</ISOAbbreviation>
</Journal>
<ArticleTitle>Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies.</ArticleTitle>
<Pagination>
<MedlinePgn>421-433</MedlinePgn>
</Pagination>
<Abstract>
<AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Reducing postoperative opioid consumption is a priority given its impact upon recovery, and the efficacy of ketamine as an opioid-sparing agent in children is debated. The goal of this study was to update a previous meta-analysis on the postoperative opioid-sparing effect of ketamine, adding trial sequential analysis (TSA) and four new studies.</AbstractText>
<AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">A comprehensive literature search was conducted to identify clinical trials that examined ketamine as a perioperative opioid-sparing agent in children and infants. Outcomes measured were postoperative opioid consumption to 48 h (primary outcome: postoperative opioid consumption to 24 h), postoperative pain intensity, postoperative nausea and vomiting and psychotomimetic symptoms. The data were combined to calculate the pooled mean difference, odds ratios or standard mean differences. In addition to this classical meta-analysis approach, a TSA was performed.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Eleven articles were identified, with four added to seven from the previous meta-analysis. Ketamine did not exhibit a global postoperative opioid-sparing effect to 48 postoperative hours, nor did it decrease postoperative pain intensity. This result was confirmed using TSA, which found a lack of power to draw any conclusion regarding the primary outcome of this meta-analysis (postoperative opioid consumption to 24 h). Ketamine did not increase the prevalence of either postoperative nausea and vomiting or psychotomimetic complications.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This meta-analysis did not find a postoperative opioid-sparing effect of ketamine. According to the TSA, this negative result might involve a lack of power of this meta-analysis. Further studies are needed in order to assess the postoperative opioid-sparing effects of ketamine in children.</AbstractText>
</Abstract>
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<LastName>Michelet</LastName>
<ForeName>Daphnée</ForeName>
<Initials>D</Initials>
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<Affiliation>Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France.</Affiliation>
</AffiliationInfo>
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<LastName>Hilly</LastName>
<ForeName>Julie</ForeName>
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<Affiliation>Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France.</Affiliation>
</AffiliationInfo>
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<LastName>Skhiri</LastName>
<ForeName>Alia</ForeName>
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<Affiliation>Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France.</Affiliation>
</AffiliationInfo>
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<ForeName>Rachida</ForeName>
<Initials>R</Initials>
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<Affiliation>Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Diallo</LastName>
<ForeName>Thierno</ForeName>
<Initials>T</Initials>
<AffiliationInfo>
<Affiliation>Department of Anesthesia and Intensive Care, Robert Debre University Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Brasher</LastName>
<ForeName>Christopher</ForeName>
<Initials>C</Initials>
<AffiliationInfo>
<Affiliation>Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia.</Affiliation>
</AffiliationInfo>
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<LastName>Dahmani</LastName>
<ForeName>Souhayl</ForeName>
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</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Paris Diderot University, Paris, France. souhayl.dahmani@rdb.aphp.fr.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France. souhayl.dahmani@rdb.aphp.fr.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>Department of Anesthesiology, Intensive Care and Pain Management, Robert Debre Hospital, 48 Bd Sérurier, 75019, Paris, France. souhayl.dahmani@rdb.aphp.fr.</Affiliation>
</AffiliationInfo>
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<Chemical>
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