Intravenous infusion of ketamine versus fentanyl for postoperative analgesia in spine surgeries

Abstract

Objective The aim of this study was to compare the intraoperative hemodynamics and postoperative recovery profile and analgesia while using ketamine versus fentanyl infusion in patients undergoing spine surgery. Background Acute pain management is an important aspect of perioperative anesthetic care. Inadequate postoperative analgesia contributes to adverse outcomes including immunosuppression, hyperglycemia, poor rehabilitation, and progression to chronic pain. Patients and methods This prospective trial included 60 adult patients with American Society of Anesthesia status I or II (undergoing elective spine surgery under general anesthesia in neurosurgery operation room of Menoufia University Hospital. They were divided into two groups of 30 patients each. In group A, analgesia is maintained intraoperative and postoperatively till 24 h with ketamine infusion (0.02–0.2 mg/kg/h). In group B, analgesia is maintained intraoperatively with fentanyl infusion (1–2 mcg/kg/h) and continued 24 h after operation. We assessed heart rate, mean arterial pressure, and duration of operation. Recovery score (Modified Aldrete Scoring System), visual analogue scale, total analgesic consumption, sedation score (Ramsey score), and occurrence of any complication in the form of nausea and vomiting, hallucination, skin rashes, or any other complications were recorded. Results There is a highly significant statistical difference between ketamine group and fentanyl group regarding hemodynamics, sedation score, visual analogue scale, first call of analgesia, and occurrence of complications. P > 0.05 was considered not statistically significant. P ≤ 0.05 was considered statistically significant. P ≤ 0.001 was considered statistically highly significant. Conclusion Low-dose ketamine infusion is more effective in postoperative pain management after spine surgery when compared with fentanyl as it maintains intraoperative hemodynamic stability and provides good postoperative analgesia. It decreases incidence of complications associated with the use of opioid infusion.