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AN EVALUATION OF THE EFFECTIVENESS OF PREEMPTIVE KETAMINE IN PRODUCING POST-OPERATIVE ANALGESIA IN PATIENTS SCHEDULED FOR ELECTIVE THYROIDECTOMY
ABSTRACT
Background: One of the main goals of peri-operative anaesthetic care is to ensure adequate
postoperative pain control and optimize patients’ satisfaction with analgesia. Preemptive analgesic
techniques have been suggested and are being investigated for their effectiveness in achieving this
goal. Consequently, the use of pre-incision low-dose ketamine as a preemptive analgesic modality
is increasingly being considered, and has so far led to inconclusive and conflicting findings. In an
effort to contribute to further clarity on this subject, this study evaluated the effectiveness of pre
incision low-dose (0.5mg/kg) ketamine in producing post-operative analgesia in patients scheduled
for elective thyroidectomy.
Methodology: Following approval by the Hospital’s Ethical Review Board, eighty–two adult
patients scheduled for elective thyroidectomy under general anaesthesia at the University of Ilorin
Teaching Hospital were recruited into this study. The patients were randomly allocated into one of
two groups, to receive either 0.5mg/kg of ketamine (made up to 5ml) or an equal volume of normal
saline, ten minutes before surgical incision. All patients were premedicated with oral diazepam.
Monitors were placed for baseline assessment and patients were preoxygenated with 100% oxygen
for 3 minutes. General anaesthesia was instituted, with induction of anaesthesia using intravenous
propofol 1.5 – 2mg/kg. Thereafter endotracheal intubation was facilitated with intravenous
suxamethonium chloride 1- 1.5mg/kg. Intra-operative analgesia was provided with intravenous
fentanyl and standard monitoring was continued, including continous SpO2, heart rate,
capnography, non-invasive blood pressure and ECG. At the end of surgery, pain scores, using
verbal rating scale (VRS) over 24 hours, time to first request for analgesic (TFA), total opioid
(morphine) consumption in 24 hours postoperatively, patients’ satisfaction with analgesia and
incidence of ketamine side effects were assessed.
Results: The two groups were comparable with respect to demographic characteristics and
baseline clinical variables. There was no significant difference in the postoperative pain scores.
The median pain scores at 30 min, 2 hr, 6 hr, 12 hr and 24 hr postoperatively for the ketamine and
saline groups were not significantly different (P values 0.208, 0.185, 0.412, 0.590 and 0.854
respectively). The time to first request for analgesic were also comparable in the two groups: 86.00
± 56.58 minutes in the ketamine group and 79.90 ± 68.05 minutes in the saline group(P =
0.357).The 24-hr opioid consumptions were comparable: 11.00 ± 3.16 mg in the ketamine group
and 13.21 ± 5.87 mg in the control group (P=0.275). Patients’ satisfaction with analgesia was also
comparable in both groups (P= 0.988) and side effects associated with ketamine were absent at the
dose used.
Conclusion: It is concluded that administration of pre-incision low-dose (0.5mg/kg) ketamine did
not produce a preemptive analgesic effect in patients who had elective thyroidectomy.
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