The efficacy of intravenous ketamine in major abdominal surgery

Abstract

The postoperative pain associated with major abdominal surgery by laparotomy is considered severe. It also involves peripheral and central sensitisation phenomena, defining primary and secondary hyperalgesia respectively, and allodynia phenomena. The perioperative administration of antihyperalgesic substances such as ketamine and the reduction of intraoperative opioid use in a multimodal anaesthesia and analgesia protocol has been the subject of numerous studies. The aim of this study is to evaluate the efficacy of intraoperative and postoperative IV ketamine in major abdominal surgery A prospective, comparative, randomised, double-blind study was conducted in the general surgery department of the Mostaganem University Hospital. Over a two-year period from March 2023 to March 2025, 84 patients underwent major abdominal surgery by laparotomy, comparing two groups of patients. Group P1 (n=43) received an IV lidocaine bolus (bolus + continuous infusion) and group P2 (n=41) received ketamine (bolus + continuous infusion) in addition to lidocaine. Additional analgesia was provided by IV paracetamol and nefopam (ACUPAN) and titrated morphine to achieve the analgesic target (EN ≤ 3). Data collected on morphine consumption 24 hours after surgery and DPO scores for coughing and resting at various post-operative times on the numerical scale (EN). Morphine consumption during the first 24 hours was reduced in both groups but significantly lower in the P2 group with lower DPO scores at rest and during mobilisation (P < 0.001). The results clearly demonstrated that the efficacy of ketamine in addition to xylocaine led to significant savings in morphine consumption 24 hours after surgery in a multimodal analgesia strategy and significantly reduced DPO scores in static and dynamic conditions.

Keywords: postoperative hyperalgesia, DPO, ketamine