Low-Dose Ketamine Infusion for Perioperative Pain Management in Patients Undergoing Laparoscopic Gastric Bypass: A Prospective Randomized Controlled Trial

Abstract

Introduction. Obesity is a common comorbidity seen in the perioperative setting and is associated with many diseases including cardiovascular disease and obstructive sleep apnea. Laparoscopic Roux-en-Y gastric bypass is the gold standard surgical treatment for patients whose weight is refractory to diet and exercise. Caring for these patients perioperatively presents unique challenges to anesthesiologists and is associated with an increased risk of adverse respiratory events. In our study, we hypothesize that a low-dose perioperative ketamine infusion will reduce opioid consumption and improve analgesia when compared to standard therapy. Methods. This is a single-center, prospective randomized controlled study enrolling 35 patients in total. Patients were randomized equally into the ketamine and control group. Preop, intraop, and postop management regimens were standardized. The ketamine group received a 0.3 mg/kg ideal body weight ketamine bolus after induction followed by a 0.2 mg/kg/hr ketamine infusion continued into the postop setting for up to 24 hours. Data collected included total perioperative opioids used converted to oral morphine equivalents (ME), pain scores, side effects, hospital length of stay, and patient satisfaction captured via postoperative questionnaires. Results. The use of perioperative opioid consumption was significantly lower in the ketamine group when compared with the control group (179.9 ME versus 248.7 ME, P = 0.03 ). There was no statistically significant difference in pain scores or hospital length of stay postoperatively between the two groups. There were also no reported adverse respiratory events, prolonged sedation, agitation, or other side effects reported in either group. The patient satisfaction questionnaires showed a significant difference with the ketamine group reporting lower maximum pain scores, a decrease in how pain limited activities of daily living once discharged, and increased hospital pain management satisfaction scores. Conclusions. Perioperative low-dose ketamine infusions significantly reduced opioid consumption in morbidly obese patients undergoing laparoscopic gastric bypass surgery.

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

“…Conversely, Ali et al observed that ketamine failed to decrease fentanyl consumption intraoperatively in obese patients undergoing abdominoplasty surgery. A study conducted by Seman et al showed ketamine reduced fentanyl consumption intraoperatively [ 21 ]. This discrepancy may be due to differences in infusion regimens across studies [ 22 ].…”

Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

“…Acetaminophen (or paracetamol) significantly reduced the pain score at the end of anesthesia (MD: −1.88) [27,33], 2 h (MD: −1.53) [33], 8 h (MD: −1.8) [33], and 12 h (MD: −1.63) [33] after surgery (Table 1). Ketamine significantly reduced the pain score at 60 min (MD: −1.31) [20,40,49,50], 2 h (MD: −1.03) [20,40,49,50], and 12 h after surgery (MD: −0.43) [42,45,49,50] (Table 1). Dexmedetomidine significantly reduced the pain score at 30 min (MD: −1.36) [17,31,49], 60 min (MD: −1.24) [15,17,31,47,49], 2 h (MD: −0.87) [15,31,49], 4 h (MD: −3.10) [36], 6 h (MD: −0.44) [22,31,47,49], and 48 h (MD: −0.80) [17,47] after surgery (Table 1).…”

“…The characteristics of the included RCTs are available for consultation in SMC2. An analysis shows that out of the total participants, 1795 patients were allocated to the control (1491 placebo or no intervention and 304 to a comparator), while 1775 were allocated to treatment (135 to Ibuprofen [28,33], 207 to acetaminophen (or paracetamol) [25,27,29,33], 329 to ketamine [16,20,37,39,40,42,43,45,49,50,52], 23 to ketamine plus clonidine [18], 68 to ketamine plus magnesium [39,42], 391 to dexmedetomidine [15,17,22,26,31,36,47,49], 341 to lidocaine [21,26,38,41,44,46,47,51], 70 to magnesium [34,48], 112 to gabapentin [23,32,35], 69 to pregabalin [19,30], and 30 to pregabalin plus dexmedetomidine [24]). Regarding the comparison between treatment and the comparator, acetaminophen was compared with ibuprofen in 89 patients …”

“…The detailed reasons for the risk of biased judgments are available in SMC4. [25,27,29,33], 329 to ketamine [16,20,37,39,40,42,43,45,49,50,52], 23 to ketamine plus clonidine [18], 68 to ketamine plus magnesium [39,42], 391 to dexmedetomidine [15,17,22,26,31,36,47,49], 341 to lidocaine [21,26,38,41,44,46,47,51], 70 to magnesium [34,48], 112 to gabapentin [23,32,35], 69 to pregabalin [19,30], and 30 to pregabalin plus dexmedetomidine [24]). Regarding the comparison between treatment and the comparator, acetaminophen was compared with ibuprofen in 89 patients [28,33], clonidine with dexmedetomidine in 30 patients [22], ketamine with dexmedetomidine in 54 patients [47,…”

The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery

“…Its incorporation into opioid-free anaesthesia (OFA) protocols has shown signi cant bene ts. Seman et al (2021) [5] reported that total perioperative opioid consumption was signi cantly lower in the ketamine group compared to the control group (179.9 morphine equivalents (ME) versus 248.7 ME, P = 0.03). Postoperative patient-controlled analgesia (PCA) opioid administration was also signi cantly lower in the ketamine group (90.6 ME versus 137.6 ME, p = 0.04).…”