To compare the effect of ketamine versus dexmedetomidine spray at the surgical site during closure in lumbar spine fixation surgery for postoperative pain relief: Prospective, randomized, double-blinded, placebo-controlled study.

Abstract

Background: Lumbar spine surgeries are associated with severe postoperative pain due to the extensive handling of tissue and bone. Multimodal analgesia is the preferred choice but is associated with systemic side effects. Atomized drugs at the local surgical site may be a more attractive option than the intravenous route. In this study, we compare the atomized form of ketamine and dexmedetomidine at the surgical site for postoperative pain relief in lumbar spine surgeries.

Methods: After approval from institutional ethics committee and the Clinical Trial Registry - India, 45 patients of age group between 18 and 60 years, scheduled for lumbar spine surgery under general anesthesia were divided into three equal groups: Group D: Received dexmedetomidine 1 µ/kg, Group K: Received Ketamine 1 mg/kg and Group N: Received 20 ml of normal saline. Drugs were diluted in 20 mL of normal saline and applied over the surgical site at the end of the surgery, before closure, in the form of fine droplets using an atomizer device. Our primary outcome was the postoperative analgesia measured by the Visual Analog Scale.

Results: Duration of postoperative analgesia was significantly higher in the ketamine group, 240 min (interquartile range [IQR]: 120-360) than the dexmedetomidine group, 120 min (IQR: 120-240) determined by the Kruskal-Wallis test (P < 0.001).

Conclusion: Atomized ketamine and dexmedetomidine at the surgical site during closure in lumbar spine fixation surgery is an attractive choice for postoperative pain relief without any systemic side effects.