APRIL 9, 2026
Research on the impact of ketamine for enhanced recovery after surgery (ERAS) protocols remains limited.
However, new data indicate ketamine does not decrease hospital length of stays and could lead to a higher chance of ending up in the ICU (Br J Anaesth 2026 Jan 20. doi:10.1016/j.bja.2025.12.013).
In the pragmatic, randomized, double-blind, placebo-controlled, single-cluster trial, the investigators evaluated the impact of ketamine on postoperative outcomes in patients undergoing major
Research on the impact of ketamine for enhanced recovery after surgery (ERAS) protocols remains limited.
However, new data indicate ketamine does not decrease hospital length of stays and could lead to a higher chance of ending up in the ICU (Br J Anaesth 2026 Jan 20. doi:10.1016/j.bja.2025.12.013).
In the pragmatic, randomized, double-blind, placebo-controlled, single-cluster trial, the investigators evaluated the impact of ketamine on postoperative outcomes in patients undergoing major abdominal surgery within established ERAS protocol.
Each patient was randomized to receive either ketamine or saline placebo bolus at induction of general anesthesia, followed by an intraoperative and postoperative infusion for 48 hours. The investigators sought primary outcomes of hospital length of stay and secondary outcomes of total opioid consumption and the incidence of side effects and adverse events.
The study included 1,522 patients. The results show ketamine administration ultimately did not decrease the overall length of hospital stay (OR, 1.21; 95% CI, 1.00-1.47) or opioid consumption (OR, 0.85; 95% CI, 0.71-1.01) compared with the placebo group.
The investigators also found the ketamine group had a higher chance of needing an ICU transfer (OR, 2.03; 95% CI, 1.14-3.63) and lower odds of meeting early discharge milestones (OR, 0.68; 95% CI, 0.50-0.93).
There were some similarities found between the two groups. For example, both rapid response activation (OR, 1.51; 95% CI, 0.85-2.68) and ileus requiring nasogastric decompression (OR, 1.26; 95% CI, 0.87-1.84) were similar between the placebo and ketamine groups.
Finally, the ketamine group had higher rates of debilitating dizziness (OR, 6.05; 95% CI, 3.02-12.11), debilitating hallucinations (OR, 2.69; 95% CI, 1.09-6.65), and other severe side effects (OR, 1.94; 95% CI, 1.27-2.96) compared with the placebo group.
“The addition of ketamine to a multimodal abdominal ERAS protocol provided no significant benefits and was associated with worse perioperative outcomes,” the authors wrote.
By Kenny Walter
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