A Comparative Study on the Effect of Preemptive Ketamine and Paracetamol in the Control of Postoperative Pain in Lumbar Disc Herniation Surgeries under Spinal Anesthesia

Document Type : Original Article (s)

Authors

1 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aim of this study was to compare the efficacy of preemptive ketamine with paracetamol in control of postoperative pain in lumbar disc herniation surgeries under spinal anesthesia.Methods: In a clinical trial study, 75 patients undergoing lumbar disc surgery were randomly divided in three groups of 25 patients. Before surgery, in the first group, paracetamol (1 g) was intravenously injected during 10 minutes; in the second group, ketamine (0.2 mg/kg), and in the third group, normal saline was intravenously injected with the same volume. Pain intensity and other postoperative complications were compared between the three groups.Findings: The mean intensity of postoperative pain in three groups of paracetamol, ketamine, and control was 1.62 ± 0.87, 1.64 ± 1.15, and 2.52 ± 1.64 (P = 0.018) at the entrance to recovery, 1.84 ± 1.18, 1.76 ± 1.10, and 3.72 ± 1.97 (P < 0.001) at the 30th minutes recovery, and 1.84 ± 1.18, 1.92 ± 1.12, and 3.72 ± 1.65 (P < 0.001) at the 60th minute recovery, respectively, and the differences between the three groups were significant. Besides, the trend of pain intensity up to 60 minutes of recovery were different between the three groups, and the control group had a higher pain intensity (P = 0.001).Conclusion: The use of paracetamol has a good effect on postoperative pain management in spinal disk surgeries. Since paracetamol has low side effects, and is most commonly used by patients, it is preferable to ketamine.

Keywords

References

  1. Rudra A, Chaterjee S, Ray S, Ghosh S. Pain management after spinal surgery. Indian J Pain 2015; 29(1): 9-14.
  2. Coley KC, Williams BA, DaPos SV, Chen C, Smith RB. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth 2002; 14(5): 349-53.
  3. Cohen BE, Hartman MB, Wade JT, Miller JS, Gilbert R, Chapman TM. Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia. Spine (Phila Pa 1976) 1997; 22(16): 1892-6.
  4. Bernard JM, Surbled M, Lagarde D, Trennec A. Analgesia after surgery of the spine in adults and adolescents. Cah Anesthesiol 1995; 43(6): 557-64. [In French].
  5. Le Roux PD, Samudrala S. Postoperative pain after lumbar disc surgery: A comparison between parenteral ketorolac and narcotics. Acta Neurochir (Wien) 1999; 141(3): 261-7.
  6. Popping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 2008; 101(6): 832-40.
  7. Jellish WS, Abodeely A, Fluder EM, Shea J. The effect of spinal bupivacaine in combination with either epidural clonidine and/or 0.5% bupivacaine administered at the incision site on postoperative outcome in patients undergoing lumbar laminectomy. Anesth Analg 2003; 96(3): 874-80.
  8. Rahmanian M, Leysi M, Hemmati AA, Mirmohammadkhani M. The effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia: A randomized clinical trial. Oman Med J 2015; 30(1): 11-6.
  9. Rivkin A, Rivkin MA. Perioperative nonopioid agents for pain control in spinal surgery. Am J Health Syst Pharm 2014; 71(21): 1845-57.
  10. Imani F, Faiz HR, Sedaghat M, Hajiashrafi M. Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery. Anesth Pain Med 2014; 4(1): e12162.
  11. Faiz HR, Rahimzadeh P, Visnjevac O, Behzadi B, Ghodraty MR, Nader ND. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: Results of a prospective, randomized, double-blind, multicenter clinical trial. J Pain Res 2014; 7: 65-70.
Journal of Isfahan Medical School
Volume 36, Issue 466 - Serial Number 466
January and February 2018
Pages 64-69

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History

  • Receive Date: 08 November 2017
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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