Analgesia for positioning of spinal anesthesia in elderly patients with proximal femoral fracture under dexmedetomidine infusioin: Ketamine versus fentanyl

Abstract

Background Changes in posture due to spinal anesthesia in instances of femur fracture can cause severe pain and stress in elderly patients. Dexmedetomidine (DEX) infusion is effective in preventing stress and inducing sleep, but DEX alone has limitations in controlling the pain caused by postural changes. To improve pain relief, we compared the analgesic effects of intravenous DEX–ketamine and DEX–fentanyl combinations to facilitate lateral positioning for spinal anesthesia in proximal femoral fractured patients. Methods Forty-six patients were randomly assigned to the group K or group F. Group K was intravenously given ketamine (1 mg/kg) for 10 minutes, while group F received intravenous fentanyl (1 mcg/kg) for 10 minutes. All patients in both groups received concomitantly a bolus of DEX 1 μg/kg over 10 minutes. Ten minutes after the administration of ketamine with DEX or fentanyl with DEX, patients were placed in the lateral position with the fracture site positioned up. Pain score and quality scores during spinal anesthesia (i.e., lateral positioning, hip flexion, and spinal block) were recorded. Results Pain scores during lateral positioning and hip flexion were significantly lower in group K than in group F (P < 0.0001). The quality scores of patients during all periods of spinal anesthesia were significantly lower in Group K than in Group F (P < 0.05). Hemodynamic parameters were not significantly different between the two groups. Conclusions Intravenous DEX–ketamine is a more effective combination of the lateral position for spinal anesthesia in patients undergoing surgery for proximal femoral fracture in comparison with intravenous DEX–fentanyl.

Comparison of Ketamine and Tramadol for Prevention of Shivering During Spinal Anesthesia

“…Therefore, in the current investigation, we noticed a significant incidence of nystagmus, hallucination, nausea, vomiting, and sweating. These findings are comparable to those found in previous studies (Lee et al, 2020;Liang et al, 2022;Zangouei et al, 2019). In the trial that MB Rabi'u et alcarried out, none of the patients in the ketamine group was shivering, which is in contrast to the data that we obtained (10 %) (Rabi'u et al, 2019).…”

Pericapsular nerve group block for analgesia of positioning pain during spinal anesthesia in hip fracture patients, a randomized controlled study

“…Pain during positioning for spinal anesthesia was assessed and categorized into one of the following grades as modified from previous studies [6,11,12]; grade 1: Sitting without pain and with minimal help, grade 2: patient complains of mild pain detected by grimacing or verbal expression, grade 3: patient expresses severe pain but can tolerate positioning with help, grade 4: patient cannot tolerate positioning and required additional analgesia. Also, the best angle obtained by the patient during spinal anesthesia was classified into the following categories; A: Good flexion (angle more than 90), B: average flexion (angle less than 90) without twisting or using the hands for support, and C: Poor flexion and/or twisting or hand support.…”

“…However, severe pain, encountered during positioning for spinal anesthesia, can complicate the technique and worsen the patient experience. Different regional blocks were employed to facilitate patient positioning for spinal anesthesia including femoral nerve block (FNB), fascia iliaca compartment block (FICB), and lateral cutaneous nerve block (LCNB) [5][6][7][8].…”

An experience of subglottic airway foreign body removal in a patient under tracheal intubation: a case report

“…In the present case, since the patient was suspected to have PRIS and/or MH (although a definitive diagnosis had not been made), we could not use propofol or MH-associated drugs such as sevoflurane [ 9 , 10 ] and used a combination of dexmedetomidine and ketamine. Because this combination is more likely to preserve spontaneous breathing and has a higher analgesic effect [ 11 ], the removal procedure could be performed under spontaneous breathing even if extubation was performed. Although there are many other choices such as remifentanil and midazolam, it would be safe to select anesthetics with which anesthesiologists are familiar.…”