Comparison of Intravenous Diclofenac Sodium With or Without Pre-Emptive Ketamine for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy Under Spinal Anaesthesia. A Comparative Multimodal Analgesia Approach

BACKGROUND AND AIMS: Pre-emptive analgesia is initiated before surgery in order to prevent the establishment of central sensitization during intra-operative and early post-operative period. Multimodal analgesia relates a balanced approach to treat post-operative pain by combining multiple therapeutic agents and regional techniques. This study was conducted to evaluate the post-operative analgesic efcacy and safety of intravenous water based diclofenac sodium with or without pre-emptive intravenous ketamine in patients undergoing total abdominal hysterectomy under spinal anaesthesia. METHODS: This was a prospective, randomized, double blinded controlled comparative tertiary hospital based study. Three groups of 30 patients each, i.e., receiving diclofenac with and without pre-emptive ketamine and control group were enrolled. The time of rst analgesic request, total analgesic requirement in rst 24h, intra-operative and post-operative vitals, any side effects and complication were recorded. RESULTS: Statistically signicant differences were observed in post-operative mean VAS scores between T30m to T24h, mean time of requirement of rst dose of rescue analgesia request was longer in patients in group DK (373±9.39 min.), as compared to group NS (179.13±5.95min.) and group D (228.30±7.97min.), post-operative requirement of analgesia in rst 24h was lower in group DK (1.27±0.45) as compared to group NS (2.86±0.44) and group D (1.67±0.55), and quality of analgesia among the three groups (p=0.001). CONCLUSION: Pre-emptive use of ketamine with intravenous diclofenac sodium as a part of multimodal analgesia regimen render the patient pain-free in immediate post-operative period and minimize the demand of rescue analgesic.