Perioperative Ketamine and Esketamine for Enhanced Recovery After Surgery (ERAS): A Systematic Review.

In 30 seconds

This systematic review assessed perioperative ketamine and esketamine within enhanced recovery after surgery (ERAS), drawing on randomized trials, reviews, meta-analyses, and clinical guidelines. It examined pain, opioid use, nausea and vomiting, cognition, depressive symptoms, and sleep, with evidence graded using GRADE. The review found that both agents consistently reduced postoperative pain and opioid consumption, particularly during the first 24–48 h. Moderate-certainty evidence also supported esketamine-associated improvements in postoperative nausea and vomiting and early sleep quality, while evidence on neurocognitive outcomes remained insufficient.

Key findings

• Ketamine or esketamine consistently reduced postoperative pain and opioid consumption, particularly during the first 24–48 h after surgery.
• Both agents were associated with fewer early postoperative depressive symptoms, especially in patients with preexisting depression.
• Moderate-certainty evidence supported esketamine-associated improvements in postoperative nausea and vomiting and sleep quality within 72 h.
• Evidence on postoperative delirium and cognitive dysfunction was insufficient.

Why it matters

ERAS care aims to support recovery while limiting postoperative pain and opioid exposure. This review suggests ketamine and esketamine may contribute to multimodal analgesia and may also affect early mood, nausea, and sleep outcomes. The findings are relevant to evaluating these agents as perioperative adjuncts, but uncertainty across outcomes means benefits should be interpreted in light of the evidence quality and variability.

What to keep in mind

The review reports high heterogeneity, small and underpowered studies, inconsistent or non-standardized outcome measures, short follow-up, and uncertainty about optimal dosing.