Postoperative analgesia in bariatric surgery: effect of pre-incisional single dose ketamine
Karbonskienė A., Kasputytė G.
Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Background and Goal of Study: Remifentanil infusions provide excellent intraoperative analgesia with rapid emergence in different patient groups. But postoperative analgesia is still a challenge after this type of anaesthesia. Low-dose intravenous ketamine seems promising in reducing postoperative opioid requirements and opioid induced hyperalgesia. Our aim was to evaluate an effect of pre-incisional single injection of low-dose ketamine on postoperative analgesic requirements and patient satisfaction with postoperative analgesia in laparoscopic bariatric surgery.
Materials and Methods: 32 consecutive bariatric patients were randomly assigned to receive single pre-incisional injection of ketamine (0,15 mg/kg) (K group) or saline (S group) in a double-blind manner. Standardized protocol of anaesthesia based on remifentanil infusion (0,2-0,5 mcg/mg/kg) and sevoflurane was followed. Postoperative analgesia was provided with bupivacaine infiltration of operative ports and standardized doses of acetaminophen, ketoprofen and intravenous morphine to reach acceptable pain level. Patients' satisfaction with analgesia was recorded.
Results: Both groups were did not differ in demographic values, BMI, operative time, intraoperative remifentanil consumption. Postoperative pain scores were similar. Morphine consumption was 10,0 (min-max 7,0 – 12,5) mg in S group and 9,0 (min-max 3,0 – 15,0) mg in K group (p= 0,022). Both groups demonstrated equally high satisfaction with postoperative analgesia.
Conclusion: pre – incisional single dose ketamine results in slight reduction of morphine consuption postoperatively. High patient satisfaction is achieved if multimodal analgesia protocol is followed.