LOW-DOSE KETAMINE INFUSION DURING SURGERY DECREASES ACUTE PAIN AFTER ORTHOPEDIC SURGERY. OUR ANESTHETIST-ORTHOPEDIC SURGEON JOINT EXPERIENCE

Luai K. Aldaklalah MD*, Mohanad A. Odat MD, Sami A. Alrwashdeh MD, Eyas M. Alzuqaili MD and Deyaaldeen I. A. Alrashdan MD.

ABSTRACT

Background: Pain attitude is various according to type of operative intervention.Some relief methods for pain after surgery are: Pre-emptive analgesics, multimodal analgesics, epidural analgesia, nerve block, patient controlled analgesia and oral analgesics. Aim: To assess the influence of low-dose ketamine infusion during surgery with general anesthesia on pain after orthopedic surgery. Methods: Our prospective, randomized and double blind investigation included 111 patients, of both sexes, aged 29-71 yrs and scheduled for orthopedic surgery during the year 2018 at Haya military hospital, Ajlun, JORDAN. Patients were divided into two groups. Group I patients (GI, n=55) were administered ketamine hydrochloride infusion (5 mcg/kg/minute) and group II patients (GII, n=56) were administered normal saline 0.9%, both immediately after intubation and maintaining till wound closure. A visual analogue scale (0 = no pain to 10 = most intense pain) was used to record patient's score of pain at rest at 1, 2, 8 and 24 hours postoperatively. First analgesic demand and morphine use after surgery were recorded. General anesthesia was induced in which intravenous fentanyl 3 mcg/kg was administered. Immediately before wound closure, all patients were administered intravenous 3 mg morphine. Analgesia in the recovery room was performed using morphine in increments of 3 mg every 10 minutes until the VAS pain score was 3. Statistics: For comparison of parameters other than gender between the two groups, the t-test was used. For comparison of gender, Chi square test was used. Morphine use and VAS pain scores were compared using variance. P-value less than 0.05 was considered statistically significant. Results: Low-dose ketamine infusion increased the time to first analgesic demand and decreased morphine use after surgery at 1, 2, 8 and 24 hours (P < 0.05).VAS scores were significantly less in group I than in group II, after surgery (P<0.05). Conclusion: Low-dose ketamine infusion during surgery decreased pain and analgesic use after surgery.

Keywords: During surgery: ketamine; After surgery: pain, morphine; Orthopedic surgery; general anesthesia.