• Jianwei Wang, Zifeng Xu, Zhou Feng, Rui Ma, and Xiaoyu Zhang.
• Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine.
• Pain Physician. 2020 Mar 1; 23 (2): 135-148.

BackgroundThe pain control effect of ketamine versus control in women during cesarean operation is not well determined.ObjectivesThe present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia.Study DesignWe used meta-analysis to address this concern.SettingMeta-analysis-based study.MethodsThe databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software.ResultsA total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], -1.10; 95% confidence interval [CI], -1.61, -0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, -6.11 mg; 95% CI, -9.93, -2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001).LimitationsLimited patients were included with moderate strength.ConclusionsKetamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia.Key WordsKetamine, cesarean section, randomized controlled trials, meta-analysis.

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