Spinal anestezi altında artroskopik diz cerrahisinde düşük doz intravenöz ketaminin postoperatif ağrı yönetimindeki etkinliği

Yıl 2025, Cilt: 8 Sayı: 6, 1060 - 1064, 25.10.2025

Dilşad Özkavak , Ayfer Nazmiye Yılmaz , Yeliz Kılıç , Sadık Özkavak , Nermin Göğüş

https://doi.org/10.32322/jhsm.1724244

Öz

Amaçlar: Bu çalışmanın amacı, spinal anestezi altında artroskopik diz ameliyatı geçiren hastalarda intraoperatif düşük doz (subanestetik) intravenöz (IV) ketaminin postoperatif analjezi üzerindeki etkinliğini belirlemektir.
Yöntemler: Kırk hasta eşit olarak kontrol ve ketamin grupları olarak sınıflandırıldı. Ketamin grubuna ameliyatın sonuna doğru subanestetik doz ketamin (0,15 mg/kg bolus IV) uygulanırken, kontrol grubundaki hastalara hiçbir ilaç verilmedi. İlk analjezik ilaca duyulan ihtiyaç, ilk analjezik ilacın uygulanmasına kadar geçen süre ve postoperatif dönemde ek (ikinci) analjezik gereksinimi gruplar arasında karşılaştırıldı.
Sonuçlar: Kontrol grubundaki tüm hastalar ve ketamin grubundaki 8 hasta (%40) postoperatif olarak ilk analjezik ilaca ihtiyaç duydu (p<0,001). İlk analjezik ilaç uygulamasına kadar geçen ortalama süre ketamin grubunda (8,5 saat) kontrol grubuna (4,2 saat) göre daha uzundu (p=0,008). Kontrol grubundaki üç hastada ek bir analjezik ilaç gerekliyken, ketamin grubundaki hastaların hiçbiri ikinci bir analjezik ilaç gerekmedi. Hasta memnuniyeti açısından, kontrol grubunda 11 (%55) hasta "iyi" ve 9 (%45) hasta "çok iyi" olarak derecelendirilirken, ketamin grubundaki tüm hastalar "çok iyi" olarak derecelendirildi (p<0,001).
Sonuç: Ameliyat sırasında subanestezik doz IV ketamin, elektif artroskopik diz cerrahisinde kabul edilebilir yan etki oranlarıyla, ameliyat sonrası analjezinin süresini uzatır ve analjezik ihtiyacını azaltır.

Anahtar Kelimeler

Artroskopik diz cerrahisi , ketamin , postoperatif analjezi , spinal anestezi

The effectiveness of low-dose intravenous ketamine on postoperative pain management in arthroscopic knee surgery under spinal anesthesia

Öz

Aims: This study aimed to determine the efficacy of intraoperative low-dose intravenous ketamine on postoperative analgesia in patients who were underwent arthroscopic knee surgery under spinal anesthesia.
Methods: Forty patients were equally classified as control and ketamine groups. In the ketamine group, 0.15 mg/kg intravenous ketamine was administered between 35-45. minutes of the surgery, whereas the patients in the control group received no medication. Postoperative pain was assessed using a visual analogue score. An analgesic, intravenous tramadol, was administered if the patients showed a value of at least 5 on the VAS. The need of first analgesic drug, the time to first analgesic drug administration, and additional (second and third) analgesic requirement during the postoperative period were compared between the groups.
Results: All patients in the control group and 8 (40%) patients in the ketamine group required first analgesic drug (p<0.001) postoperatively. The mean time to first analgesic drug administration was longer in the ketamine group (8.5 hours) than in the control group (4.2 hours) (p=0.008). Ten patients in the control group needed second analgesic drug whereas only one patient needed the second analgesic in the ketamine group. Third analgesic drug was required in three patients of the control group while none of the patients in the ketamine group needed third analgesic. For patient satisfaction, 11 (55%) patients marked “good” and 9 (45%) marked “very good” in the control group whereas all patients in the ketamine group marked “very good” (p<0.001).
Conclusion: Intraoperative subanesthetic dose IV ketamine prolongs the duration of postoperative analgesia and reduces the need for analgesics in elective arthroscopic knee surgery, with an acceptable side effect rates.

Anahtar Kelimeler

Arthroscopic knee surgery , ketamine , postoperative analgesia , spinal anesthesia

Kaynakça

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