Background: Head and neck surgeries are often associated with significant postoperative pain and hemodynamic instability. Opioid-sparing strategies are essential to improve recovery outcomes and minimize opioid-related adverse effects. This study aimed to compare the analgesic efficacy and perioperative effects of intraoperative low-dose ketamine versus a perioperative combination of low-dose ketamine and dexmedetomidine.
Methods: A prospective, randomized, double-blind clinical trial was conducted on 90 adult patients undergoing elective head and neck surgery. Patients were assigned to one of three groups (n=30 each): normal saline (control), intraoperative ketamine infusion (0.3 mg/kg/h), or perioperative ketamine (0.3 mg/kg/h) plus dexmedetomidine (0.5 µg/kg/h). The primary outcome was postoperative pain score assessed via the Numeric Rating Scale (NRS) at multiple intervals. Secondary outcomes included total morphine consumption, time to first rescue analgesia, hemodynamic stability, and patient satisfaction.
Results: The ketamine–dexmedetomidine group reported significantly lower pain scores across all time points, with a median NRS of 1 at 24 hours compared to 1 in the ketamine group and 3 in the control group. This group also showed the longest time to first analgesia request [median 18 hours], and the lowest morphine requirement [median 10 mg] versus 9 hours/15 mg in the ketamine group and 3 hours/20 mg in controls. Heart rate and mean arterial pressure were consistently more stable in the combination group. Satisfaction was highest in the ketamine–dexmedetomidine group (50% excellent rating).
Conclusion: Perioperative infusion of ketamine and dexmedetomidine provides superior analgesia, better hemodynamic stability, and higher patient satisfaction compared to ketamine alone or control. This combination may serve as an effective opioid-sparing strategy in major head and neck surgeries.
Keywords: Ketamine, Dexmedetomidine, Head and Neck Surgery, Postoperative Pain, Hemodynamic Stability.
Introduction
Head and neck surgeries are complex, lengthy procedures often associated with significant blood loss and hemodynamic instability. Maintaining intraoperative stability and ensuring smooth emergence from anesthesia are crucial to minimize postoperative complications, especially in surgeries involving major vascular structures (1). Agitation and coughing during extubation can provoke dangerous fluctuations in heart rate and blood pressure, increasing the risk of adverse outcomes. Therefore, effective perioperative anesthetic management and pain control are essential to enhance recovery, reduce morbidity, and improve overall prognosis (2).
Adequate postoperative analgesia not only facilitates early recovery and mobility but also prevents complications such as wound infections, thromboembolism, and prolonged hospitalization. While opioids remain the cornerstone of pain relief, their use is limited by side effects like respiratory depression and tolerance (3). Ketamine, an NMDA receptor antagonist, offers effective analgesia at low doses, reducing opioid requirements and associated risks (4). Similarly, dexmedetomidine provides hemodynamic stability and analgesic-sparing effects without respiratory depression, though its delayed onset limits its utility. Combining ketamine with dexmedetomidine may enhance analgesia while minimizing the individual drawbacks of each drug (5, 6).
Therefore, the aim of this study is to compare the analgesic efficacy of intraoperative infusion of low dose ketamine vs. low dose ketamine and dexmedetomidines perioperatively in head and neck surgeries.
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