Pre-emptive intravenous ketamine analgesia in patients undergoing laparoscopic cholecystectomy: a prospective double blind randomised controlled trial

WANG Shir Siong, Nurlia YAHYA, Shereen TANG Suet Ping, Maryam BUDIMAN, Aliza MOHAMAD YUSOF, Muhammad Zurrusydi ZAINUDDIN, Nadia MD NOR, Felicia LIM Siew Kiau

Department of Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

ABSTRACT

Introduction: Pre-emptive analgesia is a technique that is initiated before noxious stimuli is experienced and has been shown to lower the pain intensity when compared to analgesics administered after the surgical incision. As previous studies were inconclusive in determining the optimal dose, this prospective double blind randomised controlled trial was carried out to evaluate if pain could be alleviated when comparing low doses of intravenous ketamine for pre-emptive analgesia. Materials and Methods: Seventy eight patients undergoing laparoscopic cholecystectomy were prospectively recruited and randomised into 3 groups after obtaining written consent: Group 1 (placebo); Group 2 (IV ketamine 0.25 mg/kg); and Group 3 (IV ketamine 0.5 mg/kg). All study drugs were given 5 minutes after endotracheal intubation prior to surgical incision. Blood pressure and heart rate were recorded before and after induction of anaesthesia and subsequently at 5 minute intervals for 30 minutes after the study drug was given. Post-operative pain control was evaluated through visual analogue scale (VAS) at 0, 3, 6, 12 and 24 hours post-operatively. Any adverse effects of ketamine were documented. Results: Group 3 patients had significantly lower VAS scores at 0, 3, 6 and 24 hours post-operatively compared to patients in Group 1. Groups 1 and 2 patients did not have significantly different VAS scores throughout the study period. Haemodynamic parameters including heart rate and mean arterial pressure were not significantly different among the three groups. Side effects documented were nausea, vomiting and blurring of vision. Conclusion: IV ketamine 0.5 mg/kg showed significant pre-emptive analgesic effects when compared to IV ketamine 0.25 mg/kg and placebo, in patients undergoing laparoscopic cholecystectomy.

Keywords: ketamine, analgesia, pain relief, laparoscopic cholecystectomy, adverse effects

Correspondence author: Shereen Tang, Department of Anaesthesiology & Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455788/ 91455783. E-mail: shereen_tang@yahoo.com

Brunei Int Med J. 2015; 11 (6): 288-296