Ketamine/Esketamine May Reduce Postoperative Pain and Opioid Use After Laparoscopic Cholecystectomy: Study
A new study published in the journal of Anaesthesia Critical Care & Pain Medicine showed that in individuals having laparoscopic cholecystectomy (LC), ketamine/esketamine may lessen initial postoperative discomfort and the need for postoperative opioids.
One of the most popular minimally invasive abdominal operations is laparoscopic cholecystectomy, yet, patients often have considerable initial postoperative pain, which can prolong recovery and increase the need for opioids. N-methyl-D-aspartate receptor antagonists ketamine and its S-enantiomer esketamine have well-established analgesic and opioid-sparing effects. Their use as perioperative adjuncts to multimodal analgesia has drawn increasing attention.
It is therapeutically significant to assess how well they manage immediate postoperative pain following laparoscopic cholecystectomy. The safety and efficacy of perioperative ketamine and esketamine in patients having laparoscopic cholecystectomy were examined in this comprehensive review and meta-analysis.
Up to April 2025, Medline, Google Scholar, Embase, and clinicaltrials.gov were searched for relevant material. Included were 48 randomized controlled studies (RCTs) that evaluated postoperative pain ratings in LC patients and compared ketamine/esketamine with a control. To do statistical analysis, R was used.
The number of RCTs in this study was 48 (n = 3,508). When comparing the intervention to the control, pooled analysis showed that it significantly decreased postoperative pain at 4 (mean difference [MD]: -1.11, I² = 97.8%, p = 0.044, very low-certainty evidence), 6 (MD: -0.40, I² = 86.1%, p = 0.019, very low-certainty evidence), 24-hour opioid consumption (MD: -4.10, I² = 98.3%, p = 0.024, very low-certainty evidence), and the need for rescue analgesia (risk ratios [RR]: 0.64, I² = 36%, p = 0.006, very low-certainty evidence).
Esketamine substantially decreased postoperative pain at 1 (MD: -0.67, I²=0%, p = 0.034) and 2 hours (MD: -0.91, I²=79.3%, p = 0.008), according to subgroup analysis based on regimen. Ketamine dramatically decreased the requirement for rescue analgesia (RR: 0.64, I²=41.7%, p = 0.011) and 24-hour opioid use (MD: -5.35, I²=96%, p = 0.01). A safety investigation showed that the intervention considerably raised the risk of nystagmus, diplopia, and hallucinations. Overall, this meta-analysis showed that ketamine/esketamine may assist lower initial postoperative pain and postoperative opioid requirements in patients undergoing LC, but with very little assurance.
Source:
Akram, U., Fatima, E., Ashraf, H., Abdul Rehman, K., Raza, M. A., Qazi, M. S., Ahmad, E., Rehman, F. K. U., Chaudhary, A. J., Ratnani, I., & Surani, S. (2026). Perioperative ketamine or esketamine for acute postoperative pain after laparoscopic cholecystectomy: A systematic review and meta-analysis with meta-regression. Anaesthesia, Critical Care & Pain Medicine, 101762. https://doi.org/10.1016/j.accpm.2026.101762
