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KMID : 1189320230170050894
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Asian Spine Journal
2023 Volume.17 No. 5 p.894 ~ p.903
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Comparison of Intraoperative Low-Dose Ketodex and Fentanyl Infusion for Postoperative Analgesia In Spine Surgery: A Prospective Randomized Double-Blind Study
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Priya Thappa
Nidhi Singh
Ankur Luthra
Kwon Hye-Ji
Rajeev Chauhan
Shyam C. Meena
Vishal Kumar
Navneet Singla
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Abstract
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Study Design : Prospective randomized double-blind study.
Purpose : To assess the analgesic effects of the combination of a low-dose ketamine and dexmedetomidine (ketodex) infusion and compare it with that of fentanyl for postoperative analgesia after spine surgeries.
Overview of Literature : Adequate pain management following spine surgeries is crucial. Approximately 57% of patients experience inadequate pain control in the first 24 hours following elective spine surgery, which is attributable to the extensive soft tissue and muscle damage.
Methods : The study included 60 patients graded American Society of Anesthesiologists I and II and scheduled for thoracolumbar spine surgery involving >3 vertebral levels. The patients were divided into two groups: group KD (ketodex) and group F (fentanyl). The primary objective was to compare the postoperative analgesic requirements among the groups. The secondary objectives included a comparison of the intraoperative anesthetic requirements, postoperative pain scores, hemodynamic parameters, side effects of the study drugs, and the duration of post-anesthesia care unit stay of both the groups.
Results : Ketodex use prolonged the mean time to first rescue analgesia (22.00±2.30 hours vs. 11.69±3.02 hours, p<0.001) and reduced the requirement of rescue analgesics in the first 24 hours postoperatively compared to fentanyl use (70.00±8.16 μg vs. 113.31±36.65 μg, p=0.03). The intraoperative requirement of desflurane was comparable between the groups (p>0.05). The postoperative pain scores were significantly lower in the group KD than in group F at most timepoints (p<0.05). Patients in group KD had a shorter post-anesthesia care unit stay than group F did (p<0.001).
Conclusions : Low-dose ketodex could be a safe substitute for fentanyl infusion when employed as an anesthetic adjuvant for patients undergoing thoracolumbar spine surgeries involving >3 vertebral levels to achieve prolonged analgesia without any opioid-related side effects.
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KEYWORD
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Dexmedetomidine, Fentanyl, Ketamine, Ketodex, Analgesia, Spine
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