Efficacy of low-dose ketamine as sole analgesic agent in maintaining analgesia and intraoperative hemodynamics during laparoscopic gynecological surgeries

Saxena, Dipti; Dixit, Atul; Kumar, Naina; Arya, Bipin; Sanwatsarkar, Sadhana; Bhandari, Shilpa

doi:10.4103/0259-1162.206276

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Figure 4 shows comparison of Ramsay Sedation Score (RSS) between Ketamine and Control group at different time intervals over 24 hours. Both the groups had comparable Ramsay sedation score at 90 mins till 24 hours which is also in accordance with the study conducted by Guignard et al, 8 Saxena et al, 14 they used low dose Ketamine as sole analgesic in patients undergoing laparoscopic gynecological surgeries and observed that in only 3 patients (4.28%) a Ramsay sedation score of 5 was seen just after extubation.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Sardeshpande,

Deshmukh

2023

IJCA

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The use of Ketamine, an NMDA receptor antagonist, in sub-anesthetic doses for analgesia is increasingly being administered in inpatient settings with acute pain service guidance and in outpatient settings under a variety of models. At sub-anesthetic doses, ketamine possesses centrally mediated analgesic properties with minimal effects on consciousness and cognition.In this study we have compared the efficacy of IV low-dose Ketamine as an adjunct to conventional systemic analgesia to examine preventive effect on post-operative pain and opioid consumption in patients undergoing laparotomies.The study was carried out on 50 patients, 25 patients received a pre-incisional IV bolus of 0.15 mg/kg of Ketamine,10 mins before the incision followed by IV infusion of 2mcg/kg/min continued for 24 hours postoperatively in addition to systemic analgesia (Group K)and 25 Patients received IV bolus of Normal Saline 10 min before the incision, followed by an IV infusion of normal saline (Group C) till 24 hours post-op and systemic analgesia alone. Saline bolus and infusion were given at equivalent volume/rate of the study group. The analgesic efficacy was judged by NRS (Numeric Pain Rating Scale), Time to first rescue analgesia (TFA) and Total opioid consumption (Tramadol in mg) in 24 hours. Ketamine related side effects were also recorded.Patients in the Ketamine group had significantly lower Mean total opioid consumption (88.04 ± 29.07 mg vs. 210 ± 23.93 mg)and Numerical pain Rating Scale (NRS) (3.13 +0.34 vs. 4.44+ 0.77). Time to first rescue analgesia was significantly delayed in Ketamine group as compared to Control group (20.65 ± 9.2 mins vs. 5.4 ± 5.38 mins). Ramsay Sedation scores (RSS) were significantly higher in the Ketamine group (2.4 +0.76vs. 1.52 +0.51)in the immediate post-operative period. There were no demonstrable side-effects related to Ketamine in Group K.Pre-emptive IV low-dose Ketamine is an effective adjunct to systemic analgesia in abdominal surgeries as it significantly prolongs the time to first rescue analgesia (TFA), reduces mean total analgesic requirement and lowers pain scores (NRS) in the post-operative period with negligible side effects.

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Section: Discussionsupporting

confidence: 90%

“…Ketamine, an NMDA receptor antagonist, is an interesting option. The various studies [8][9][10][11][12][13][14][15] as per the site of surgery, duration and dosing regimen of low-dose ketamine warrants its promising profile in management of post-op pain.…”

Section: Discussionmentioning

confidence: 99%

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Sardeshpande,

Deshmukh

2023

IJCA

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“…Recent studies showed its ability to effectively control pain and minimize opioid use intraoperativly. 30 There is also evidence that intraoperative ketamine use results in improved postoperative pain control and decreased need for postoperative opioids. 31,32 Although thoracic blocks were looked at before in autologous breast reconstruction, 24,28 complete thoracic block including a parasternal block has never been reported.…”

Section: Discussionmentioning

confidence: 99%

“…We noted that the use of intraoperative ketamine in our protocol was associated with less TMEC. Recent studies showed its ability to effectively control pain and minimize opioid use intraoperativly 30 . There is also evidence that intraoperative ketamine use results in improved postoperative pain control and decreased need for postoperative opioids 31,32 …”

Section: Discussionmentioning

confidence: 99%

The Role of Maximal Locoregional Block in Autologous Breast Reconstruction

et al. 2022

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Background: Enhanced Recovery After Surgery (ERAS) has become the standard of care in microsurgical breast reconstruction. The current literature provides overwhelming evidence of the benefit of ERAS pathways in improving quality of recovery, decreasing length of hospital stay, and minimizing the amount of postoperative narcotic use in these patients. However, there are limited data on the role of using maximal locoregional anesthetic blocks targeting both the abdomen and chest as an integral part of an ERAS protocol in abdominally based autologous breast reconstruction. The aim of this study is to compare the outcomes of implementing a comprehensive ERAS protocol with and without maximal locoregional nerve blocks to determine any added benefit of these blocks to the standard ERAS pathway. Methods: Forty consecutive patients who underwent abdominally based autologous breast reconstruction in the period between July 2017 and February 2020 were included in this retrospective institutional review board-approved study. The goal was to compare patients who received combined abdominal and thoracic wall locoregional blocks as part of their ERAS pathway (study group) with those who had only transversus abdominis plane blocks. The primary end points were total hospital length of stay, overall opioids consumption, and overall postoperative complications. Results: The use of supplemental thoracic wall block resulted in a shorter hospital length of stay in the study group of 3.2 days compared with 4.2 days for the control group ( P < 0.01). Postoperative total morphine equivalent consumption was lower at 38 mg in the study group compared with 51 mg in the control group ( P < 0.01). Complications occurred in 6 cases (15%) in the control group versus one minor complication in the thoracic block group. There was no difference between the 2 groups in demographics, comorbidities, and type of reconstruction. Conclusion:The maximal locoregional nerve block including a complete chest wall block confers added benefits to the standard ERAS protocol in microvascular breast reconstruction.

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“…which demonstrated that ketamine in a dose of 0.5 mg.kg -1 preoperatively followed by repeated doses of 0.25 mg.kg -1 every ½ h in patients undergoing laparoscopic gynecological surgery provided stable intraoperative hemodynamics. [ 22 ]…”

Section: Discussionmentioning

confidence: 99%

Comparative study of retrobulbar block versus ketamine infusion during eye enucleation/evisceration (randomized controlled trial)

Ali

Elbadawy

2020

Anesth Essays Res

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Background: The aim of this study is to compare the safety and efficacy of retrobulbar block versus intraoperative ketamine infusion in eye enucleation or evisceration under general anesthesia. Materials and Methods: Forty-five patients belonging to American Society of Anesthesiologists Physical Status I and II undergoing eye enucleation or evisceration were randomly allocated to three equal groups (15 patients each). General anesthesia was used as the standardized technique in all patients. Group R received a single retrobulbar injection, Group K received intravenous ketamine infusion, and Group C received normal saline with the same rate of ketamine infusion. Intraoperative heart rate and mean arterial pressure, recovery time, postoperative pain score, time to first rescue analgesic, number of patients who required rescue analgesia, and any adverse events were reported. Results: Postoperative pain Visual Analog Scale was significantly lower in R and K groups in comparison to the C group and was significantly higher in K than R group at 3, 6, 12, and 24 h. In addition, the time to first rescue analgesic was significantly longer in R group (429 ± 54 min) than that in K group (272 ± 34 min), but compared to both groups, it was longer in C group (52 ± 7 min). In K group, the recovery time was longer with higher sedation score in comparison to the other two groups. Conclusions: Single retrobulbar injection and low-dose ketamine infusion are safe and effective when used as adjuvants to general anesthesia, but retrobulbar block provides better control of postoperative pain with prolonged time to first rescue analgesic and reduced analgesic consumption.

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Efficacy of low-dose ketamine as sole analgesic agent in maintaining analgesia and intraoperative hemodynamics during laparoscopic gynecological surgeries

Cited by 6 publications

References 22 publications

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

Intravenous low-dose ketamine in addition to systemic analgesia versus systemic analgesia alone for post-operative pain management in laparotomies:Adouble-blind randomised controlled study

The Role of Maximal Locoregional Block in Autologous Breast Reconstruction

Comparative study of retrobulbar block versus ketamine infusion during eye enucleation/evisceration (randomized controlled trial)

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