Salas2626. Salas S, Frasca M, Planchet-Barraud B, Burucoa B, Pascal M, Lapiana JM, et al. Ketamine analgesic effect by continuous intravenous infusion in refractory cancer pain: considerations about the clinical research in palliative care. J Palliat Med. 2012;15:287-93. |
20 (11 intervention, nine control) |
Palliative care unit; locally advanced or metastatic cancer and pain refractory to opioids |
A single continuous 48-h IV infusion of morphine + ketamine (0.5-1.0 mg/kg) |
A single continuous 48-h IV infusion of morphine + placebo (not described) |
Pain |
Depression, tiredness, nausea, anxiety, drowsiness, lack of appetite, well-being, shortness of breath, sedation, satisfaction |
ESAS score at baseline (T0), 2 h (T1), 24 h (T2), and 48 h (T3) |
No differences were found (T2: ketamine = 0.27-2.41 placebo = -1.13-2.53 p = 0.13; T3: ketamine = 0.60-1.43 placebo = -2.38-3.50 p = 0.08) |
One patient died in the placebo group No ketamine-related adverse effects |
Wang2727. Wang J, Wang Y, Xu X, Peng S, Xu F, Liu P. Use of various doses of s-ketamine in treatment of depression and pain in cervical carcinoma patients with mild/moderate depression after laparoscopic total hysterectomy. Med Sci Monit. 2020;26:e922028 |
417 (313 intervention, 104 control) |
Hospital; women with cervical carcinoma undergoing laparoscopic total hysterectomy |
A single IV injection 1 h after analgesia of 0.5 mg/kg R/S-ketamine (n=104), 0.5 mg/kg S-ketamine (n=104); or 0.25 mg/kg S-ketamine (n=104) |
A single IV injection 1 h after analgesia of 50 mL normal saline (104 patients) |
Depression, pain |
None |
HAMD-17 score at baseline and days 1, 2, 3, 5, and 7 |
In all treatment groups, the HAMD-17 scores were lower at 1, 2, and 3 days than in the control group (p < 0.05)The high-dose S-ketamine (0.5 mg/kg) group had the lowest HAMD-17 scores (p < 0.05) No difference at 5 postoperative days |
No difference in operative time, bleeding, length of hospital stay, or 1-month complication rate (nausea, dizziness, vomiting) |
Fan2828. Fan W, Yang H, Sun Y, Zhang J, Li G, Zheng Y, et al. Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget. 2017;8:2356-60. |
37 (20 intervention, 17 control) |
Hospital; newly diagnosed cancer (various) |
A single 40-min IV infusion of 0.5 mg/kg IV R/S-ketamine |
A single 40-min IV infusion of 0.05 mg/kg midazolam |
Suicidal ideation |
Depression |
MADRS score at baseline and days 1, 3, and 7 |
The ketamine group was less depressed on days 1 (MADRS = 24.46±8.04 vs. 31.89±7.39, p = 0.0339) and 3 (25.09±7.07 vs. 32.03±7.21, p = 0.0546) No difference on day 7 |
No increase in emergent psychiatric symptoms |
Xu2929. Xu R, Zhan Y, Chen S. Effect of intraoperative single administration of sub-anesthesia ketamine on breast cancer patients with depression. Biomed Res. 2017:552-6. |
50 (25 intervention, 25 control) |
Hospital; female patients undergoing modified radical mastectomy of unilateral breast cancer |
A single 10-min IV infusion of 0.5 mg/kg ketamine 1 h after the start of anesthesia |
A single 10-min IV infusion of isotonic saline 1 h after the start of anesthesia |
Depression |
Pain |
HAMD-17 score at baseline as well as days 1, 3 and 7 |
The ketamine group had significantly lower HAMD-17 scores than the control group at 1 and 3 postoperative days (p < 0.05) At postoperative day 7, there was no significant between-group difference (p > 0.05) |
No between-group difference in the incidence of adverse reactions The ketamine group had one case of nausea, two cases of irritability, and one case of mild respiratory depression |
Fallon3030. Fallon MT, Wilcock A, Kelly CA, Paul J, Lewsley LA, Norrie J, et al. Oral ketamine vs placebo in patients with cancer-related neuropathic pain: a randomized clinical trial. JAMA Oncol. 2018;4:870-2. |
214 (107 intervention, 107 control) |
Unspecified setting; cancer-related neuropathic pain |
Daily doses of 40-400 mg oral ketamine (2-week titration followed by fixed dose for 16 days) |
Placebo (not described) |
Pain |
Depression, anxiety |
HADS score (time points not specified) |
No between-group difference Mean HADS (ketamine) = -3.481; mean HADS (placebo) = -3.654; median difference = 0.173 (-0.500 to 0.958) |
Eight and 10 adverse events in the ketamine and placebo groups, respectively (cognitive disturbance, dizziness, fatigue, nausea, somnolence) |
Liu3131. Liu P, Li P, Li Q, Yan H, Shi X, Liu C, et al. Effect of pretreatment of s-ketamine on postoperative depression for breast cancer patients. J Invest Surg. 2021;34:883-8. |
303 (203 intervention, 100 control) |
Hospital; female breast cancer patients who received modified radical mastectomy |
A single IV infusion of 0.125 mg/kg of R/S-ketamine (n=102); or 0.125 mg/kg of S-ketamine (n=101) |
A single IV infusion of normal saline (n=100) |
Depression |
Pain |
HAMD-17 at baseline and days 3, 7, 30 and 90 |
HAMD-17 scores were lower at three days, 1 week, and 1 month after surgery in both ketamine groups when compared to the control group Scores in the S-ketamine group were lower than in the R/S-ketamine group (p < 0.05)No difference at 3 months |
No side effects are reported |
Zhou3232. Zhou Y, Sun W, Zhang G, Wang A, Lin S, Chan MTV, et al. Ketamine alleviates depressive symptoms in patients undergoing intracranial tumor resection: a randomized controlled trial. Anesth Analg. 2021;133:1588-97. |
84 (41 intervention, 43 control) |
Hospital; patients undergoing elective surgical resection of supratentorial brain tumor |
A single 40-min IV infusion of 0.5 mg/kg ketamine |
A single 40-min IV infusion of normal saline |
Depression |
Anxiety, delirium, pain |
PHQ-9 and MADRS scores at baseline; days 1, 2, and 3; and at discharge. |
The ketamine group had a higher proportion of patients with treatment response on day 3 than the placebo group (41.5 vs 16.3%, respectively; RR: 2.25, 95%CI 1.18-5.50) The rate of remission on discharge was higher with ketamine than with placebo (29.3 vs. 7.0%; RR: 4.20, 95%CI 1.28-13.80) |
Three days after surgery, there was no significant between-group difference in the number of patients who experienced manic symptoms (4.9 vs. 2.3%), psychotic symptoms (7.3 vs. 9.3%), or dissociative symptoms (7.3 vs. 2.3%) |