{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:44:29Z","timestamp":1789688669681,"version":"4.0.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background and Aims:<\/jats:title>\n Ketamine is being proposed for the prevention of rebound pain. This meta-analysis systematically reviews evidence from randomised controlled trials on the efficacy of ketamine (intravenous or perineural) in preventing rebound pain in adults undergoing surgery under regional nerve block.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A systematic search for randomised controlled trials evaluating ketamine\/esketamine (perineural or intravenous) for preventing rebound pain was conducted across databases up to March 2025. Adults receiving regional nerve block with or without ketamine\/esketamine were included. The primary outcome was the incidence of rebound pain. Secondary outcomes included onset time and severity of rebound pain, patient satisfaction, and adverse effects.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Six trials enroling 890 patients were included. Ketamine\/esketamine significantly reduced the incidence of rebound pain [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.32 to 0.59;\n P<\/jats:italic>\n < 0.00001;\n I<\/jats:italic>\n \u00b2 = 39%]. The intravenous subgroup showed a significant reduction (OR 0.48, 95% CI 0.34 to 0.68;\n P<\/jats:italic>\n < 0.00001;\n I<\/jats:italic>\n \u00b2 = 21%). The esketamine-versus-control subgroup also favoured active treatment (OR 0.37, 95% CI 0.22 to 0.64;\n P<\/jats:italic>\n = 0.0004;\n I<\/jats:italic>\n \u00b2 = 51%). Hallucinations were significantly more frequent with active treatment (OR 12.73, 95% CI 2.98 to 54.41;\n P<\/jats:italic>\n = 0.0006;\n I<\/jats:italic>\n \u00b2 = 0%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Current evidence suggests that intravenous and perineural ketamine\/esketamine reduce the incidence of rebound pain after a peripheral regional nerve block.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_100_26","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:00:14Z","timestamp":1784383214000},"page":"797-805","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Role of perioperative ketamine on the incidence of rebound pain after regional nerve block in the adult surgical population: A systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8159-5920","authenticated-orcid":false,"given":"Jeetinder K.","family":"Makkar","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5441-6787","authenticated-orcid":false,"given":"Bisman Jeet K.","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7642-529X","authenticated-orcid":false,"given":"Preet Mohinder","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1538-8728","authenticated-orcid":false,"given":"Narinder P.","family":"Singh","sequence":"additional","affiliation":[{"name":"Anaesthesia and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"R1-20260720","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1136\/rapm-2021-103083","article-title":"A multisociety organizational consensus process to define guiding principles for acute perioperative pain management","volume":"47","author":"Mariano","year":"2022","journal-title":"Reg Anesth Pain Med"},{"key":"R2-20260720","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.bjae.2017.10.002","article-title":"Regional anaesthesia and outcomes","volume":"18","author":"Hutton","year":"2018","journal-title":"BJA Educ"},{"key":"R3-20260720","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.bja.2020.10.035","article-title":"Factors associated with rebound pain after peripheral nerve block for ambulatory surgery","volume":"126","author":"Barry","year":"2021","journal-title":"Br J Anaesth"},{"key":"R4-20260720","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.jpain.2009.06.002","article-title":"Translational pain research: Achievements and challenges","volume":"10","author":"Mao","year":"2009","journal-title":"J Pain"},{"key":"R5-20260720","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.bja.2023.09.022","article-title":"Prophylactic dexamethasone for rebound pain after peripheral nerve block in adult surgical patients: Systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials","volume":"132","author":"Singh","year":"2024","journal-title":"Br J Anaesth"},{"key":"R6-20260720","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1111\/anae.16566","article-title":"Efficacy of different routes of dexamethasone administration for preventing rebound pain following peripheral nerve blocks in adult surgical patients: A systematic review and network meta-analysis","volume":"80","author":"Makkar","year":"2025","journal-title":"Anaesthesia"},{"key":"R7-20260720","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.2147\/DDDT.S356284","article-title":"Global trends and hotspots in esketamine research: A bibliometric analysis of past and estimation of future trends","volume":"16","author":"Li","year":"2022","journal-title":"Drug Des Devel Ther"},{"key":"R8-20260720","doi-asserted-by":"crossref","first-page":"749837","DOI":"10.1155\/2015\/749837","article-title":"Role of ketamine in acute postoperative pain management: A narrative review","volume":"2015","author":"Radvansky","year":"2015","journal-title":"Biomed Res Int"},{"key":"R9-20260720","doi-asserted-by":"crossref","first-page":"120152","DOI":"10.1016\/j.jns.2022.120152","article-title":"Ketamine as a therapeutic agent for depression and pain: Mechanisms and evidence","volume":"434","author":"Subramanian","year":"2022","journal-title":"J Neurol Sci"},{"key":"R10-20260720","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"R11-20260720","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R13-20260720","doi-asserted-by":"crossref","first-page":"1470205","DOI":"10.3389\/fsurg.2024.1470205","article-title":"Clinical value of esketamine combined with ropivacaine in rebound pain after brachial plexus block in patients with upper limb fractures","volume":"11","author":"Zhu","year":"2024","journal-title":"Front Surg"},{"key":"R14-20260720","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.clinthera.2020.03.004","article-title":"Effect of ketamine added to ropivacaine in nerve block for postoperative pain management in patients undergoing anterior cruciate ligament reconstruction: A randomized trial","volume":"42","author":"Zhu","year":"2020","journal-title":"Clin Ther"},{"key":"R15-20260720","first-page":"628","article-title":"Randomized controlled study on the effect of esketamine combined with sufentanil for postoperative patient-controlled analgesia on rebound pain after single nerve block","volume":"31","author":"Chen","year":"2024","journal-title":"Chin J Clin Med"},{"key":"R16-20260720","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.2147\/DDDT.S515741","article-title":"S-ketamine reduces the risk of rebound pain in patients following total knee arthroplasty: A randomized controlled trial","volume":"19","author":"Li","year":"2025","journal-title":"Drug Des Devel Ther"},{"key":"R17-20260720","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.bja.2021.11.043","article-title":"Evaluation of intraoperative ketamine on the prevention of severe rebound pain upon cessation of peripheral nerve block: A prospective randomised, double-blind, placebo-controlled study","volume":"128","author":"Touil","year":"2022","journal-title":"Br J Anaesth"},{"key":"R18-20260720","doi-asserted-by":"crossref","first-page":"463","DOI":"10.2147\/DDDT.S448336","article-title":"Efficacy of intravenous administration of esketamine in preventing and treating rebound pain after thoracic paravertebral nerve block: A prospective randomized, double-blind, placebo-controlled trial","volume":"18","author":"Zeng","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"R19-20260720","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11916-023-01134-1","article-title":"The emerging role of ketamine in acute postoperative pain management","volume":"27","author":"Edinoff","year":"2023","journal-title":"Curr Pain Headache Rep"},{"key":"R20-20260720","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s11916-023-01128-z","article-title":"Perioperative use of ketamine","volume":"27","author":"Adegbola","year":"2023","journal-title":"Curr Pain Headache Rep"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/ija.ija_100_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:00:16Z","timestamp":1784534416000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.4103\/ija.ija_100_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_100_26","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-01-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}