Dexmedetomidine versus ketamine for preemptive caudal analgesia in single-level lumbar laminectomy: A randomized controlled trial.
Mostafa Mohamed Elsayed, Hend Mostafa Ahmed Abosaifa, Gihan Eissa Zahran, Nashwa Mohammed Ibrahiem, Nahla Mohammed Eldeeb, Hend Abdelmonem Elsakhawy, Wafaa Ali Abd Elhadi, Khadiga A Ismail, Osama Allam Mandour, Mahmoud Mostafa Elshamy, Mohammed Gaber Saad, Ahmed Mosaad Ahmed El Naggar, Ahmed Mohammed Ragab, Mohamed Youssef Hassan, Mohammed Ali A Majrashi
Abstract
Open AccessBACKGROUND: Postoperative pain following spine surgeries remains a persistent challenge for patients, surgeons, and healthcare facilities. A wide range of medications, including ketamine and dexmedetomidine, are used for analgesia in lumbosacral spine surgeries. This study compares the efficacy, hemodynamic effects, and side effects of adding dexmedetomidine versus ketamine as adjuvants to 0.25% bupivacaine for postoperative analgesia following lumbar laminectomy. METHODS: This prospective, randomized, double-blinded study was conducted on 60 adult patients scheduled for elective discectomy/laminectomy of the lumbosacral spine. Patients were categorized into 2 groups: the dexmedetomidine group (1 µg/kg with 20 mL of 0.25% bupivacaine) and the ketamine group (0.5 mg/kg with 20 mL of 0.25% bupivacaine). The primary outcome was postoperative analgesia assessment using the visual analog scale. Secondary outcomes included intraoperative analgesia assessment by monitoring end-tidal sevoflurane levels, hemodynamic parameters, and fentanyl requirements. Postoperative hemodynamic parameters and time to rescue analgesia were also evaluated. RESULTS: The study demonstrated that dexmedetomidine provided more prolonged analgesia and better immediate postoperative pain control compared to ketamine. This was evidenced by a significantly longer time to rescue analgesia and lower visual analog scale scores in the dexmedetomidine group. Hemodynamic stability was better in the dexmedetomidine group, as evidenced by significantly lower and more stable intraoperative and postoperative heart rate and blood pressure values. CONCLUSION: Dexmedetomidine provides superior postoperative analgesia and pain control in the immediate postoperative period compared to ketamine. However, both drugs showed comparable efficacy at later postoperative times, indicating ketamine remains an option for pain management in certain circumstances.