EFFECT OF ADDING LOW-DOSE KETAMINE TO TRAMADOL INFUSION IN PCA PUMP ON POST-OPERATIVE PAIN FOLLOWING MAJOR LUMBAR SPINE SURGERIES: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Effective post-operative pain management is crucial following major lumbar spine surgery. This prospective observational study evaluated the effect of adding low-dose ketamine to tramadol patient-controlled analgesia (PCA) on post-operative pain, tramadol consumption and patient satisfaction. Methods: Forty patients (ASA I-III, aged 18-65 years) undergoing major lumbar spine surgery were assigned to receive either tramadol alone (Group T, n=20) or tramadol plus ketamine (Group TK, n=20) via PCApump. Pain scores (VRS), hemodynamic variables, oxygen saturation, tramadol consumption, rescue analgesic requirements and patient satisfaction were assessed at various time points postoperatively. Results: VRS scores at 2, 4, 8, 12, and 16 hours post-operatively were significantly lower in Group TK (p<0.05). Cumulative tramadol consumption at 24 hours was also significantly lower in Group TK (p<0.05). Rescue analgesic requirements were significantly less in Group TK (p<0.05). Patient satisfaction was significantly higher in Group TK (p<0.05). Hemodynamic variables and oxygen saturation remained comparable between groups. The incidence of nausea was similar between groups (p>0.05). Conclusions: The addition of low-dose ketamine to tramadol PCA provided superior analgesia, reduced tramadol consumption, decreased rescue analgesic needs and improved patient satisfaction following major lumbar spine surgery, without significant hemodynamic or respiratory side effects.