Surgical site infiltration using ketamine versus bupivacaine for postoperative analgesia following appendicectomy

Abstract

Background Appendicectomy is the standard surgery to remove an inflamed appendix and prevent peritonitis and other serious complication of a perforated appendix. Relieving postappendicectomy pain can help in early mobility and rehabilitation. The study compares the efficacy of using ketamine versus bupivacaine for surgical site infiltration for postoperative analgesia following appendicectomy. Methods We enrolled 60 patients aged between 14 and 50 with ASA status class I and II undergoing uncomplicated appendicectomy under general anesthesia. Patients were randomly divided into two equal groups where group 1 received surgical site infiltration using plain bupivacaine at the end of the operation while group 2 received surgical site infiltration using ketamine. The visual analog scale (VAS) was estimated at zero, 1, 2, 6, 12, and 24 h after surgery. The time until the first need for analgesia and the overall analgesic consumption were recorded in both groups. Any adverse effects in the recovery room were recorded. Postoperative hemodynamics were also recorded every 2 h for up to 24 h. Results The VAS score at 1, 2, 6, and 12 h was significantly lower in the ketamine group than in the bupivacaine group (P < 0.001). The time until the first need for analgesia was significantly prolonged in the ketamine group than in the bupivacaine group (P value < 0.001). The total ketorolac and morphine consumption in the first 24 h postoperatively was significantly lower in the ketamine group than in the bupivacaine group (P value < 0.001). Postoperative nausea and vomiting (PONV) occurred in five (16.667%) patients in the bupivacaine group and in six (20%) patients in the ketamine group. Conclusions Surgical site infiltration using either ketamine or bupivacaine can be used safely and efficiently to control acute postoperative pain and decrease the total consumption of systemic analgesics; however, ketamine infiltration seems superior in this field.