Ketamine Versus Pregabalin for Opioid Sparing After Spinal Fusion
This network meta-analysis provides procedure-specific, indirect comparative data on two common opioid-sparing adjuncts, informing multimodal protocol design after spinal fusion.
Ketamine might outperform pregabalin in reducing opioid use post-spinal fusion.
Spinal fusion surgery results in significant postoperative pain and high opioid usage, posing a risk for adverse events. Comparing ketamine and pregabalin's effectiveness helps optimize pain management. Ketamine decreased 24-hour opioid use compared to pregabalin 150 mg, but pregabalin 300 mg showed no significant difference. Pain scores were similar across groups. Ketamine may offer more opioid reduction, but findings are imprecise. Larger, direct head-to-head studies are needed to confirm efficacy and safety. Ketamine may provide better opioid-sparing effects than pregabalin in spinal fusion cases.
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Citation:Coffin M, Azhar MZ, Shepherd W, et al. Comparison of Ketamine and Pregabalin on Postoperative Opioid Usage and Pain Management in Spinal Fusion: Systematic Review and Network Meta-analysis. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2026;153:112239. doi:10.1016/j.jocn.2026.112239
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Executive Summary
Study Design
Patient Population
Primary Outcomes
Secondary Outcomes & Safety Profile
Pharmacist Implications
Clinical Pearls
Limitations
Controversies & Evidence Gaps
Cost & Logistics
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