Effect of Subanaesthetic Dose of Ketamine on Pneumoperitoneal Response and Clinical Recovery in Patients Undergoing Laparoscopy

Abstract

Objective: Although suppression of intraperitoneal gas insufflation response is possible with a higher dose of opioids, sedatives, and inha- lational agents, delayed emergence and poor clinical recovery are still a matter of concern. Here our primary aim was to assess the quality of recovery and the secondary aim includes postinsufflation response, postoperative pain intensity, total opioid requirement, and looking for adverse effects, if any.

Methods: This prospective randomized double-blinded controlled study was conducted among 75 American Society of Anesthesiologist physical status I and II patients scheduled for laparoscopic surgeries under general anaesthesia. Group 1 received injection tramadol 1 mg kg-1 iv-1 5 minutes after intubation. Similarly, groups 2 and 3 received 0.25 mg kg-1 and 0.5 mg kg-1 injection of ketamine iv, respectively. Intraperitoneal insufflation response was observed from the beginning of insufflation till 15 minutes. Clinical recovery was measured in terms of vigilance, cognition, orientation, and comfort. Postoperative pain intensity was assessed at varying movement activities using numerical rating scale pain score and with the total opioid requirement. The collected data were analyzed using three-way ANOVA.

Results: Groups 1 and 2 had a fair clinical recovery. Postoperative pain intensity was least in group 2, and the postinsufflation mean arterial pressure was higher in groups 1 and 3. A total of 32% of participants had delirium in group 3.

Conclusions: Clinical recovery and perioperative analgesia were better in ketamine group (0.25 mg kg-1) without any perturbations in intra- operative pneumoperitoneal response. Hence it can be considered an optimal adjuvant in laparoscopic surgeries.

Figure 1.

Randomization flow chart.

Figure 2.

Distribution of pain score at rest among the study groups.

Figure 3.

Distribution of pain score at slight movement among study groups.

Figure 4.

Distribution of pain score at deep breathing among study groups.