Abstract
Background and Objectives: Pain after laparoscopy results from the stretching of the intraabdominal cavity, peritoneal infiltration, and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Proper postoperative analgesia is essential in facilitating early mobilization and discharge of these patients. Administration of systemic analgesics before surgery, is one of the methods to achieve this goal, attempting to capitalize on a pre-emptive analgesic effect. This study evaluated the pre-emptive effect of a small dose of ketamine on pain contoll after the diagnostic gynecologic laparoscopies.
Materials and Methods: Sixty infertile, ASA I, II women were evaluated in this prospective, randomized, double-blined, and placebo-controlled clinical trial. After general anesthesia, 30 patients received preincision ketamine 0.4 mg/kg Iv, and in other 30 patients normal saline was administered. Pain score (Visual Analogue Scale), analgesic consumption, side effects, and time of discharge were recorded.
Results: Patients received preincision ketamine had lower pain score in the first 6 hours after operation compared with the placebo group (p<0.001). The mean time of first request for analgesia in the ketamine group was longer than the placebo group (108±20 min vs 32±10 min respectively; p<0.001). The mean analgesic consumption in the ketamine group, was less than that in the placebo group (50±25 mg vs 125±25 mg respectively; p<0.001). Time to discharge from postanesthesia care unit (PACU) was similar in two groups. Hemodynamic variables and side effects were not significantly different between two groups.
Conclusion: Pre Operative administration of Small dose of vetamine is safe, and provides preemptive analgesia in patients undergoing diagnostic gynecologic laparoscopies.