Research Abstract
Background and Objectives: Postoperative pain and stress elicit
hormonal changes. We aimed at comparing the effects of wound
infiltration with ketamine versus dexmedetomidine on postoperative
pain and stress response.
Methods: This double-blinded study included ninety patients scheduled
for total abdominal hysterectomy and were randomly assigned into
three groups to receive local wound infiltration with 40 mL of 0.25%
bupivacaine (group C), plus 2 mg/kg ketamine (group K) or 2 lg/kg
dexmedetomidine (group D). Primary outcome was postoperative
morphine consumption; secondary outcomes included first request of
analgesia, VAS scores at rest and movement (VAS–R/M) and side effects.
Serum cortisol, prolactin and glucose levels at baseline, pre-infiltration,
6 and 24 h postoperatively were measured.
Results: Rescue analgesia was less in K (6.80 3.19 mg) and D
(8.39 3.86 mg) compared to C (13.33 4.01 mg) (p 0.05). First
request of analgesia was delayed in K (7.60 4.16 h) and D
(6.00 3.73 h) compared to C (4.20 1.13 h) (p 0.05). Both VAS
and R/M were significantly lower in K (all over 24 h) and D (for 8 and
4 h, respectively) compared to C. Stress markers were significantly lower
in K and D compared to C at 6 and 24 h, and in K compared to D at
24 h (p 0.05).
Conclusions: Local wound infiltration with ketamine or
dexmedetomidine added to bupivacaine had an opioid-sparing effect,
delayed first request of rescue analgesia, and attenuated postoperative
stress response, especially with ketamine in patients underwent total
abdominal hysterectomy.
Research Authors
S.A. Mohamed1, D.M. Sayed2, F.A. El Sherif1, A.M. Abd El-Rahman1
