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Efficacy of Postoperative Analgesia of Local Ketamine Wound Instillation Following Total Thyroidectomy; A Randomized, Double-blind, Controlled-clinical Trial.

Abd EL-Rahman, Ahmad M. MD; El Sherif, Fatma A. MD
Clinical Journal of Pain: Post Acceptance: June 6, 2017
doi: 10.1097/AJP.0000000000000521
Original Article: PDF Only

Background: Total thyroidectomy is recommended as a line of management of thyroid cancer in a lot of cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to I.M ketamine and to placebo after total thyroidectomy.

Methods: Ninety patients aged 18 - 60 years, American Society of Anesthesiologists (ASA) class I-II, with a body weight of 50-90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into three groups to receive after hemostasis: Group (I): 1 mg/kg ketamine in a total volume of 10 mL normal saline instilled in the wound. Group (II): 1 mg/kg of intramuscular (I.M) ketamine. Group (III): 10 mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analogue scale at rest (VAS-R) and movement (VAS-M) and hemodynamics were assessed immediately, 1, 2, 4, 6, 12 and 24 hours postoperatively.

Results: Total morphine consumption was reduced and first request of analgesia was delayed in group I compared to groups II and III; and in group II compared to III (P=0.000). VAS-R and VAS-M were decreased immediately postoperatively in groups I and II in comparison to group III, group II had higher sedation scores.

Conclusion: Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison to intramuscular ketamine and placebo following total thyroidectomy.

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