The Efficacy of Bolus Epidural Morphine with Ketamine as Postoperative Analgesia after Hepatic Resection: A Randomized, Controlled, Double Blind, Study

Background: Postoperative pain management after hepatic resection remains challenging due to the narrow therapeutic index of opioids, which limits their use due to dose-dependent adverse effects. Optimizing epidural analgesia with adjuvant agents such as ketamine may enhance pain relief while reducing opioid consumption and related side effects.Objective: This study was conducted to evaluate the effectiveness and safety of bolus epidural morphine with ketamine compared to bolus epidural morphine when either added to bupivacaine for postoperative pain management in elective hepatic resection.Patients and Methods: Seventy-six patients who underwent hepatic resection were randomized to receive either epidural morphine-bupivacaine (MG group) or morphine-ketamine-bupivacaine (MKG group). The primary outcome was the time to first opioid request and 24-hour postoperative morphine consumption. Secondary outcomes included associated hemodynamic variables, postoperative pain scores, and any adverse effects. Results: Patients in Group MKG demonstrated significantly prolonged time to first analgesic request (22.58±3 vs 17.24±5 hours) and reduced 24-hour morphine consumption (3.74±1 vs 8.89±2 mg) compared to Group MG (P<0.001). VAS scores were significantly lower in MKG from 4-24 hours (P<0.001), with comparable adverse event rates between the groups (P>0.05).Conclusions: Adding ketamine to epidural morphine and bupivacaine prolongs analgesia, reduces opioid requirements, and minimizes side effects, offering a superior alternative for post-hepatectomy pain management.