The Effectiveness of Combining Intraoperative Ketamine with Postoperative Acetaminophen or Tramadol in Female Patients Undergoing Laparoscopic Cholecystectomy for Postoperative Pain Control: A Sample of Iraqi Patients

Abstract Background: Laparoscopic cholecystectomy is a frequently performed surgical procedure to treat cholecystitis. It is often accompanied by moderate to severe postoperative pain, which represents a significant concern. Objectives: To evaluate the efficacy of administering intraoperative ketamine along with acetaminophen or tramadol for controlling postoperative pain in female patients who have undergone laparoscopic cholecystectomy. Materials and Methods: A retrospective comparative study includes the records of 152 female patients who underwent elective laparoscopic cholecystectomy. Patients were divided into two groups of 76 patients, and both groups received intraoperative ketamine 0.5 mg/kg. The first group received acetaminophen intravenously and postoperatively at the end of the operation and every 8 h for 24 h, while the second group received tramadol intravenously at the end of the operation and every 8 h for 24 h. Numerical pain scores, intensity, and adverse effects were assessed and compared using SPSS statistical analysis. Results: No significant variation in pain scores was observed between groups treated with tramadol and acetaminophen during assessment periods ( P ≥ 0.05). The majority of patients who participated in this research experienced mild pain during the initial, 8th, 16th, and 24th hours. Nausea and vomiting were observed in five patients treated with tramadol, mainly during the first assessment hour. Conclusion: The combined administration of acetaminophen and intraoperative ketamine yields analgesic efficacy comparable with tramadol and ketamine. This suggests that female patients undergoing laparoscopic cholecystectomy may benefit from this alternative analgesic modality in favor of opioid medication.