The value of adding ketamine to lidocaine and bupivacaine mixture in ultrasonic-guided spermatic cord block in scrotal surgery: a randomized double-blind prospective study

Abstract

Background Spermatic cord block for scrotal surgery avoids the potential risks of neuraxial and general anesthesia and provides long-lasting postoperative analgesia. Aim The aim of this study is to evaluate the value of adding ketamine to lidocaine-bupivacaine mixture for ultrasonic-guided spermatic cord block for patients undergoing scrotal surgery. Patients and methods This study was carried out in Tanta University Hospitals on 50 patients with ASA physical status I and II, age older than or equal to 18 years, who were scheduled for elective scrotal surgery. Patients were randomly allocated into two equal groups using sealed envelopes: 25 patients received ultrasound-guided spermatic cord block by a mixture of lidocaine 5 ml (2%), plain bupivacaine 5 ml (0.5%), and 1-ml normal saline (group 1), and 25 patients received ultrasound-guided spermatic cord block by a mixture of lidocaine 5 ml (2%), plain bupivacaine 5 ml (0.5%), and ketamine (0.5 mg/kg) (group 2). Results There was no significant difference between the demographic data, patient characteristics, heart rate, mean arterial blood pressure, and oxygen saturation in the studied groups. There was significantly rapid onset and prolonged duration of blockade in group 2 and significant increase in visual analog scale score in group 1 at 6 h postoperatively, whereas a significant increase occurred in group 2 at 12 h, postoperatively. There was significant increase in group 1 regarding the amount of rescue analgesia. Conclusion In ultrasound-guided spermatic cord block in scrotal surgery, addition of (0.5 mg/kg) ketamine to lidocaine–bupivacaine mixture improves onset of the block, prolongs postoperative analgesia, and reduces the consumption of postoperative rescue analgesics.