Effect of Intravenous Infusion of Ketamine versus Fentanyl on Intraoperative and Postoperative Analgesia in Patients Undergoing Posterior Lumbar Fusion Surgery: A Blind Randomized Study

Abstract Background Use of opioids for perioperative analgesia is associated with sedation, respiratory depression and postoperative nausea and vomiting. N-methyl-D-aspartate receptor antagonist such as ketamine has both analgesic and antihyperalgesic properties. Objective Comparison between intravenous infusion of ketamine and fentanyl in patients undergoing posterior lumbar fusion surgery on postoperative analgesia. Patients and Methods A total of 60 patients who underwent elective posterior lumbar fusion were enrolled and divided into two equal groups; ketamine and fentanyl groups, with the same inclusion and exclusion criteria. Baseline vital parameters, adequacy of ventilation, surgical time from skin incision to skin closure, heart rate, mean arterial pressure, and pulse oximetry, total consumption of isoflurane, Visual Analogue Scale, total morphine consumption and sedation score (Ramsay sedation score) and occurrence of any complication were recorded. Results Postoperative VAS score was statistically significant higher in fentanyl compared to ketamine group, however, we reported statistically significant higher median of sedation score in fentanyl group. Our study showed statistically significant higher frequency of propofol 100mg and morphine 5mg consumption in fentanyl comparing to ketamine group. Conclusion Patients undergoing posterior lumbar fusion surgery, ketamine has potent postoperative analgesic effect with less opioid consumption and need for rescue sedation compared with fentanyl.