Evaluating Intraoperative Infusion of Low Dose Ketamine vs. Low Dose Ketamine and Dexmedetomidines Perioperatively in Head and Neck Surgeries

Background: Head and neck surgeries (HNS) are associated with significant postoperative pain and hemodynamic fluctuations. Opioid-sparing strategies are crucial to enhance recovery and reduce opioid-related adverse effects. This study compared the analgesic efficacy and perioperative outcomes of intraoperative low-dose ketamine (KET) versus a perioperative regimen combining low-dose ketamine with dexmedetomidine (DEX). Methods: In this double-blind, randomized clinical trial, 90 adult patients undergoing elective HNS were equally allocated into three groups (n = 30): control (normal saline), KET (0.3 mg/kg/h intraoperatively), and KET–DEX (KET 0.3 mg/kg/h + DEX 0.5 µg/kg/h perioperatively). The primary endpoint was postoperative pain assessed by the Numerical Rating Scale (NRS). Secondary outcomes included cumulative morphine consumption, time to first rescue analgesia, hemodynamic stability, and patient satisfaction. Results: The KET–DEX group demonstrated significantly lower pain scores across all time points, with a median NRS of 1 at 24 hours, compared to 1 in the KET group and 3 in controls. Time to first analgesic request was longest in the KET–DEX group (median 18 hours), with the lowest morphine use (median 10 mg) versus 9 hours/15 mg (KET) and 3 hours/20 mg (control). Hemodynamic parameters (HR and MAP) remained more stable in the KET–DEX group. Patient satisfaction was highest in the combination group, with 50% reporting excellent ratings. Conclusion: Perioperative infusion of KET and DEX offers superior analgesia, improved hemodynamic stability, and greater patient satisfaction compared to KET alone or control. This combination represents a promising opioid-sparing strategy in major HNS.