The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties

Abstract

IntroductionRhinoplasty is a reconstructive surgery that is frequently performed to correct nasal deformities. Local anesthesia alone or local and general anesthesia together can be used in this procedure. Patients experience distinct pain for 3 days after the operation, which is especially severe during the first day (1). Good analgesia should be provided during the postoperative period in order to ensure patient compliance and comfort (2). Local anesthesia is frequently used because it also contributes to analgesia. The addition of vasoconstrictors and adjuvant agents to local anesthetics reduces side effects and facilitates analgesic effect and duration with reduced local anesthetic concentrations. Epinephrine increases the duration of local anesthesia and provides good exposure (3). Agents such as neostigmine, clonidine, or opioids may also be added to increase the duration of anesthesia. However, neostigmine and opioids are not suited for rhinoplasties because they may cause nausea and vomiting, and clonidine is unavailable in many countries (4,5). Therefore, ketamine and its enantiomers are frequently used in multimodal anesthesia approaches. Ketamine has been shown to be better among other adjuvant agents in terms of efficacy and safety, pharmacokinetics, and pharmacodynamics (6).Ketamine allows preventative analgesia via 2 mechanisms: central desensitization due to antihyperalgesic effect and pain control as an N-methyl-daspartate antagonist. It has been shown that preincisional infiltration anesthesia with subanesthetic ketamine increases block time, thereby decreasing postoperative analgesic demand (7). The use of ketamine alone as a preventative analgesic remains questionable (8,9).Lidocaine-epinephrine combinations are used frequently in addition to general anesthesia for intranasal infiltration during rhinoplasty, but, to date, there is no published study on the effect of added ketamine. The objective of our study was to determine the usefulness of subanesthetic ketamine as an adjuvant to the infiltration block in terms of postoperative pain scores, analgesic demand, and patient satisfaction.Background/aim: The objective of this study was to examine the effect of addition of subanesthetic doses of ketamine to an epinephrinelidocaine solution on postoperative pain, analgesic use, and patient comfort during rhinoplasties.Materials and methods: Ninety patients were randomly divided into three groups: Group L, lidocaine with epinephrine; Group K, lidocaine with epinephrine plus ketamine; and Group S (control group), physiological saline solution with epinephrine. The local anesthetic solution was injected as preincisionally with intranasal submucosal infiltration following induction of general anesthesia. We evaluated visual pain score, analgesic demand, Wilson sedation score, and antiemetic demand at 5, 15, and 30 min and 1, 2, 4, 6, 8, 16, and 24 h after the operation. The patient satisfaction score was checked 24 h after the operation.Results: Visual pain score was significantly reduced in Group K in ...

Impact of Local Infiltration Anesthesia on Postopertive Pain Management after Rhinoplasty in Day Care Surgery

“…Different types of anaesthesia are administered in rhinoplasty. Infiltration block combining lidocaine with ketamine solution during rhinoplasty decreased pain and postoperative analgesic consumption during first 24 h after the operation ( 5 ). Articaine as a local infiltration anaesthetic administered for septoplasty procedure in comparison to lidocaine showed rapid onset of action ( 6 ).…”