Low Dose Perioperative Ketamine Infusion and it's Effect on Postoperative Pain Score, Sedation Score and Narcotic Consumption in Patients Undergoing Spine Surgery: A Prospective Randomized Double Blind Control Trial.

Low dose perioperative ketamine infusion and it's effect on postoperative pain score, sedation score and narcotic consumption in patients undergoing spine surgery: A prospective randomized double blind control trial.

INTRODUCTION:

Recent advances in pain management advoctes the use of multimodal approach for post-operative pain therapy, as it reduces the side effects of individual drugs and attenuate pain responses at various sites in painpathways.. 6 if pain is not sufficiently managed, it can lead to various post-surgical complications and chronic pain..4 opiods are one of the commonly used drugs for provision of balanced anaesthesia as well as analgesia in the post surgical period. The use of opioids lead to various side effects, acute tolerance and hefty financial constraints if used in larger doses. In Pakistan, easy availability of narcotics also cause difficulty in choice of analgesics in post-operative pain.3 Ketamine , a phencyclidine derivative and dissociative anesthetic agent can cause significant analgesia when used in subanesthetic doses..1 it possess centrally mediated analgesic potential without any significant effect on patient's wakefulness and perception in dose of ≤0.3 mg/kg IV.2 Consensus guidelines on the use of intravenous ketamine for acute pain management from the American Society of Regional Anaesthesia and Pain Medicine, the American Academy of Pain Medicine and the American Society of Anaesthesiologists 2018 supports the use of sub anesthetic bolus dose of ketamine up to 0.35 mg/kg and infusions up to 1 mg/kg/hour for acute pain as adjuncts to opioids for perioperative analgesia.1 Low-dose IV ketamine infusion decrease opioid requirement by 40%. It also decreases pain scores, but these findings are less clear. No significant adverse effects have been reported with low-dose IV infusion of ketamine when used up to 48 hours after surgery5 We conducted this study to evaluate the effects of perioperative sub-anesthetic ketamine infusion, when continued in the post-operative period for 24 hours, on post-operative pain and sedation scores, overall narcotic and analgesics comsumptions and side effects in patients undergoing spine surgery in local population. Literature review did not show any such study conducted in Pakistan till date, results of this study can help innovate strategies of multimodel analgesia In local population.

Onjective:

The main objective of this study is to compare the effects of perioperative low dose ketamine infusion on postoperative pain , sedation score, adverse effects and total analgesics consumption in a placebo-controlled design Hypothesis Perioperative low dose ketamine infusion decreases the visual analogue score and total analgesic consumption without profound side effects in the study group.