Effect of Intraperitoneal Ketamine as Postoperative Analgesia in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic surgery is gaining popularity so different modalities of pain management should be used as patients experience postoperative pain of different sources especially from the abdomen, back and shoulder region which is severe especially in first postoperative hours. Objective: We aimed to evaluate effect of intraperitoneal instillation of ketamine and normal saline on postoperative pain and analgesic requirements after laparoscopic cholecystectomy. Patients and Methods: Forty patients undergoing laparoscopic cholecystectomy were randomly allocated and divided into two groups, The ketamine intraperitoneal (KIP) group (n=20 patients), in which 0.5 mg/kg ketamine diluted in 30 ml normal saline was instilled intraperitoneally,The saline intraperitoneal (SIP) group (n=20 patients), in which 30 ml of normal saline was instilled intraperitoneally. Patients receive these drugs as follow, 16 ml in gall bladder fossa while other 14 ml under copula of diaphragm on both sides while patients were placed in 15-20-degree trendelenburg position. This was done before patients recovered from anesthesia, then patients extubated and transferred to ward. Patients were evaluated according to VAS, time to first analgesic and total analgesic requirements during 24 hours post-operative. Results: Our results showed that usage of ketamine decreases postoperative pain and analgesic consumption in the first 24 hours after surgery along with longer pain free period compared to patients who were given bupivacaine after laparoscopic cholecystectomy. In our study ketamine 0.5mg/kg was safely used as we did not observe any sign of toxicity. Conclusion: Intraperitoneal instillation of local anesthetic is an easy, cheap and safe method which provides good analgesia in the immediate postoperative period after laparoscopic surgery. Ketamine is highly effective in postoperative pain control in laparoscopic cholecystectomy without any hazards on patients.

Comparative evaluation of intraperitoneal bupivacaine and bupivacaine ketamine combined with lung recruitment for reducing postoperative shoulder pain in laparoscopic cholecystectomy

“…Regarding ketamine side effects, it is assumed that in sub-anesthetic doses, side effects are infrequent. In Shawky's study [32], perioperative administration of 0.5 mg/kg ketamine, given intraperitoneally, provides effective pain relief without side effects in patients undergoing laparoscopic surgery and this goes with our study that showed absence of any side effects in BK group. On the other hand, a study by Lee and his colleagues [36] have reported 44% incidence of psychomimetic side effects in patients who had received ketamine/ropivacaine in interscalene block.…”

“…This could be attributed to the early administration of ketamine at the beginning of the operation. This differs from Shawky's results [32] who administered ketamine at the end of operation. Their patients in ketamine group were sedated for 30 min after extubation.…”

“…Their patients in ketamine group were sedated for 30 min after extubation. Finally, regarding patients' hemodynamics, in a study done by Shawky and his colleagues [32], stable hemodynamics was noted in ketamine group throughout all postoperative 24 h. Of course, this is related to effective ketamine analgesia. And this goes with our study.…”

“…Intraperitoneal ketamine alone was used many times in different studies all with a dose of 0.5 mg/kg [10,32,33]. In those 3 studies, ketamine was injected at the end of surgery; also the effective postoperative analgesia was so obvious with very low VAS scores till 24 h postoperatively.…”

Impact of Dexmedetomidine and Fentanyl on Analgesic Efficacy and Side Effects in Post-Laparoscopic Vaginal Hysterectomy: A Comparison with Intraperitoneal Ropivacaine

“…11,12 Ropivacaine was preferred over bupivacaine due to its improved safety profile and reduced side effects, with its vasoconstrictive properties aiding in minimizing systemic absorption and lowering the risk of cardiac and neurological complications. 8,9 The addition of adjuvants like dexmedetomidine to reduce the dosages of local anesthetics such as ropivacaine has been shown to enhance analgesic efficacy while reducing potential side effects. Studies have indicated that combining ropivacaine with dexmedetomidine resulted in prolonged pain relief and decreased total pain medication requirements compared to using fentanyl.…”