Ketamine Trial Finds No Recovery Benefit, Higher ICU Transfer

Key Takeaways:

• Ketamine in major abdominal ERAS care was reported not to reduce hospital length of stay or opioid use versus placebo.
• In this trial, ketamine was associated with lower odds of meeting early discharge milestones and higher odds of ICU transfer.
• Investigators described more frequent severe adverse effects and concluded the regimen did not show overall perioperative benefit.

The comparison was also associated with greater odds of ICU transfer. Investigators studied 1,522 patients undergoing major abdominal surgery within an established ERAS protocol, testing perioperative ketamine as part of routine abdominal ERAS care.

The study described a strategy that began at induction of general anesthesia. Patients received ketamine or saline placebo as a bolus, followed by infusion during surgery and through the next 48 postoperative hours. The placebo arm was outlined as a time-matched comparator within the same perioperative workflow, layered onto a multimodal abdominal surgery recovery pathway.

Reported outcomes showed no decrease in overall hospital length of stay with ketamine versus placebo (OR, 1.21; 95% CI, 1.00-1.47). Inpatient opioid consumption was also not reported to decrease (OR, 0.85; 95% CI, 0.71-1.01).

Another recovery measure moved in the opposite direction, with lower odds of meeting early discharge milestones in the ketamine group. Across the reported recovery and opioid-related measures, results did not favor ketamine.

The authors also noted a higher likelihood of ICU transfer among patients assigned to ketamine. Debilitating dizziness and debilitating hallucinations were reported more often with ketamine than with placebo, along with higher rates of other severe side effects. These in-hospital findings linked ketamine to greater escalation of care and worse tolerability.

Investigators summarized the overall pattern as an absence of significant benefit when ketamine was added to a multimodal abdominal ERAS protocol, and they characterized the regimen as being associated with less favorable perioperative outcomes overall. This framing reflected a balance of neutral efficacy findings and worse in-hospital events, ending with an overall assessment that did not support a meaningful perioperative advantage for ketamine.