Local wound infiltration with fentanyl vs ketamine after open abdominal hysterectomy: a prospective, randomized, double-blind study

Abstract

Background & Objective: Local wound infiltration with local anesthetics is known to be an efficacious analgesic modality with minimal side effect. We evaluated the comparative analgesic effect of fentanyl with ketamine as an additive to 0.25% bupivacaine for local wound infiltration during open abdominal hysterectomy.

Methodology: Ninety female patients with ASA class I or II, aged 20–60 y, who underwent elective open abdominal hysterectomy under spinal anesthesia, were allocated randomly to one of the three groups. Patients of Group C received 30 ml of 0.25% bupivacaine, Group F received 30 ml of 0.25% bupivacaine plus 2 ml of fentanyl (100 µg), and Group K received 30 ml of 0.25% bupivacaine plus 2 mg/kg ketamine. The time to first analgesic demand and the total analgesic consumption in the first 24 h postoperatively were noted. Postoperative sedation score was also noted in all patients.

Results: Total analgesic consumption in the first 24 h postoperatively was significantly less in both Group K and F, in comparison to Group C (P = 0.001); however, there was no statistically significant difference between Group K and Group F (P = 0.706). The first call for analgesia was significantly earlier in the Group K in comparison to Groups C and F (P = 0.001). The sedation score was higher in Group K than the other two groups (P > 0.001). 

Conclusion: Local wound infiltration with ketamine as an adjuvant to bupivacaine appears to be a promising analgesic modality in open abdominal hysterectomy surgery. It has comparable analgesic effect to fentanyl when added to bupivacaine in local wound infiltration with longer duration of analgesia and minimal sedative effects.

Key words: Analgesia; Fentanyl; Hysterectomy Ketamine

Citation: Afify N, Mahdy W. Local wound infiltration with fentanyl vs ketamine after open abdominal hysterectomy: a prospective, randomized, double-blind study. Anaesth. pain intensive care 2023;27(2):250−255; DOI: 10.35975/apic.v27i2.2196

Received: February 05, 2023; Reviewed: February 20, 2023; Accepted: March 31, 2023