A randomized study to compare the efficacy and safety of ketamine, levobupivacaine, and a combination of both as pre-incision surgical site infiltration for providing postoperative analgesia in patients undergoing elective abdominal hysterectomy under general anesthesia

Objectives: We aimed to compare the postoperative Visual Analog Scale (VAS) score, requirement of additional analgesia, side-effects, and patient satisfaction among elective hysterectomy patients using ketamine, levobupivacaine, and a combination of both. Materials and Methods: A comparative study was conducted on 60 adult females, randomly divided into three groups of Group K: ketamine 1 mg/kg in saline, 20 mL, Group L: levobupivacaine 0.25%, 20 mL, and Group KL: ketamine 1 mg/kg in 0.25% levobupivacaine, 20 mL. The study drug was infiltrated 5 minutes before skin incision. The patient outcomes (hemodynamic parameters, pain, requirement of additional analgesia, and side-effects) were observed during the 24 h after surgery and compared. P < 0.05 was taken for reference in terms of significant results. Results: Group KL had the lowest pain VAS score at postoperative 1 h ( P = 0.022), 2 h ( P = <0.001), and 6 h ( P = 0.001). The time of the first dose of pethidine requirement was longer and the cumulative pethidine requirement (24 h) was significantly less in group KL ( P < 0.001). Nausea was present in six cases in group K, two cases of Group L, and none from group KL. The patient satisfaction score was significantly greater in group KL (3.30 ± 0.57) as compared to both groups K (1.90 ± 0.44) and L (2.50 ± 0.60), P = 0.0001. Conclusion: The combination of ketamine and levobupivacaine is a safe and efficacious alternative as pre-emptive analgesia among patients undergoing abdominal hysterectomies. The combination enhances relief from postoperative pain and provides much better patient satisfaction.