A Comparative Evaluation of Preoperative Intravenous Ketamine vs Dexmedetomidine on Post-Operative Opioids Consumptions in Patient Undergoing Elective Laparoscopic Cholecystectomy

Background: Postoperative discomfort frequently occurs following elective laparoscopic cholecystectomy, notwithstanding its minimally invasive characteristics. Opioids are extensively utilized for analgesia, nevertheless, their detrimental effects may impede recovery. Preoperative intravenous use of ketamine and dexmedetomidine enhances analgesia and decreases postoperative opioid consumption. This study evaluated postoperative pain severity and 24hour opioid usage with both medications. Methods: A comparison study was conducted at two hospitals for a duration of six months. Ninety patients scheduled for elective laparoscopic cholecystectomy were recruited and allocated into two equal groups: ketamine and dexmedetomidine. Postoperative pain was evaluated using the Visual Analogue Scale at 1, 2, 4, 8, 12, and 24 hours. Total opioid usage during a 24-hour period, the duration until the initial rescue analgesia, and adverse effects were documented as well. Data were analysed with SPSS version 26, with a p-value of less than 0.05 considered statistically significant. Results: Pain scores decreased in both groups within the initial 24 hours. Dexmedetomidine demonstrated reduced VAS scores over the follow-up period, exhibiting a significant difference at the 4-hour mark. The total opioid consumption was markedly reduced in the dexmedetomidine group compared to the ketamine group (14.10 ± 2.65 mg vs 16.11 ± 2.22 mg; p<0.001). The duration until the initial rescue analgesia was somewhat extended by dexmedetomidine; nevertheless, the discrepancy was not statistically significant. Dexmedetomidine was associated with a higher incidence of sedation and bradycardia, although the occurrence of nausea, vomiting, hypotension, and respiratory depression was comparable in both groups. Conclusion: Dexmedetomidine had superior opioid-sparing effects and reduced early postoperative pain scores compared to ketamine in elective laparoscopic cholecystectomy. Nonetheless, it was linked to increased sedation and bradycardia. It may thus be favoured when minimising postoperative opioid consumption is the primary objective, accompanied by suitable postoperative surveillance.