Comparison of the effects of intraoperative ketamine infusion and deksketoprofen applications on acute postoperative pain and chronic pain in patients undergoing total abdominal hysterectomy

Objective: In this study, intraoperatively used ketamine and dexketoprofen in patients undergoing total abdominal hysterectomy; We aimed to reduce the acute pain that will occur, to reduce the incidence of hyperalgesia and neuropathic pain by reducing intraoperative opioid use, and to compare the effects of the two agents on acute and chronic pain. Material - Method: After the approval of the Ethics Committee, a total of 96 patients in the ASA 1-2 group, with a BMI <30, between the ages of 18-65; dexketoprofen (D), ketamine (K) and ketamine-dexketoprofen (K-D) were divided into 3 groups by randomization method. There was no control group. Routine general anesthesia monitoring was performed, entry values were recorded, and routine general anesthesia method was applied to all patients. Maintenance was provided with 0.5-1 MAC sevoflurane inhalation and 0.1-0.25 µg/kg/min remifentanil infusion. Tramadol 1 mg/kg was administered to all patients for postoperative analgesia and antiemetic was administered. In addition to the routine anesthesia applications, 0.25 mg/kg bolus was administered to the 1st group (ketamine) during the induction phase, and a 5mcg/kg/min ketamine infusion was initiated before the surgical incision. In Group 2 (dexketoprofen), 0.25mg/kg ketamine and 50mg=2ml dexketoprofen bolus were administered during the induction phase, 5mcg/kg/min ketamine infusion was opened before the surgical incision. In the 3rd group (ketamine-dexketoprofen), 2 ml saline and 50 mg dexketoprofen bolus were administered during the induction phase, and the saline infusion was opened. At the end of the surgery, the ketamine infusion was terminated while the skin was closed. The patients' intraoperative blood pressure, pulse, saturation values, and total remifentanil - sevoflurane consumption amounts were recorded at 1-5-30-60th minutes. A patient-controlled analgesia device prepared with tramadol was inserted in all patients postoperatively. VAS (Visual Analog Scale) values in the first 24 hours postoperatively and side effects due to drugs were recorded. All patients were questioned according to DN4 (Doluer Neuropathique 4 Questions) criteria for postoperative 1-2-3 month pain by making phone calls. Results: When the demographic data of the patients were compared between the groups, there was no statistically significant difference. (p>0.05) When the postoperative VAS scores were compared between the groups, there was a statistically significant difference. (p<0.05) 1-4-8-12-24 in 1 day postoperative follow-up. In general, the VAS score was found to be higher in group 3 (dexketoprofen) patients compared to group 1-2 who received ketamine infusion. In group 2 (ketamine dexketoprofen), the VAS score was significantly lower than in group 1-3. ( p<0.05) There was no significant difference when the total surgery time and total anesthesia time were compared between the groups. (p>0.05) When the total amount of remifentanil, sevoflurane and ketamine was compared between groups 1-2-3, the results were found to be statistically significant (p>0.05) When the groups were compared in terms of neuropathic pain in the postoperative 1st month, the DN4 score was found to be the lowest in the ketamine group (group 1). Group 1 (ketamine) and group 3 (dexketoprofen) DN4 scores at 1 month were found to be statistically significant. (p<0.05) Postoperative DN4 score at 1st month and 3rd month was found statistically significant in all groups. (p<0.05) Conclusion: Intraoperative subanesthetic dose of ketamine decreased the incidence of pain development by lowering postoperative acute (VAS) and chronic pain (DN4) scores; This effect was stronger when used with dexketoprofen. It also reduced the need for intraoperatively administered ketamine, remifentanil and sevoflurane. Follow-up of 3 months or more is required for chronic pain follow-up. Keywords: acute pain, chronic pain, intraoperative ketamine infusion, intraoperative dexketoprofen