Does Sub-Anesthetic Ketamine Provide Postoperative Analgesia for Third Molar Surgery?

Abstract

Despite ketamine's effectiveness as an anesthetic and its known analgesic properties, the role of ketamine in postoperative pain after third molar surgery remains unclear. Therefore, this study aimed to investigate whether patients undergoing third molar surgery who received a sub-anesthetic preoperative dose of intravenous ketamine would experience less postoperative pain. We implemented a randomized, double-blinded, placebo-controlled trial. The study sample consisted of participants undergoing third molar surgery with procedural sedation anesthesia. Participants were randomized to receive a preoperative intravenous dose of ketamine or placebo, as predictor variables. The primary outcome variable was postoperative pain intensity determined by a 10-point visual analog scale at 6-hour intervals over a period of 48hours. The secondary outcome variable was the quantity of postoperative non-opioid and opioid consumption. Other variables included the extent and difficulty of surgery performed, patient satisfaction, gender, and age. Data analysis involved descriptive statistics, multivariate analysis, and regression analysis. The P value was set at .05. A total of 134 participants were randomly enrolled into either the ketamine group (n=74, 55.2%) or placebo group (n=60, 44.8%). No statistically significant differences in the distribution of study variables were found between the groups. A small yet statistically significant (P<.05) difference was noted in the median pain score at 6hours postoperatively, with the ketamine group experiencing more pain. However, no further differences were detected at any postoperative time between the 2 groups. Similar results were obtained after adjusting for age, gender, and surgical difficulty. No difference in the amount of postoperative non-opioid or opioid medication use was found between the 2 groups. This study did not find evidence that a preoperative sub-anesthetic dose of ketamine could reduce pain after third molar surgery or have any effects on non-opioid or opioid analgesic consumption. Nevertheless, ketamine remains a valuable option among sedation medications for oral and maxillofacial surgeons.