RANDOMIZED, DOUBLE-BLIND STUDY TO COMPARE THE EFFECTS OF TWO ANALGESIC REGIMENS AS PREEMPTIVE ANALGESIA FOR PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA

Background: Preemptive analgesia is a method to provide effective pain relief after the surgery. This study was designed to compare the effects of single analgesic Ketamine intravenous (IV) versus combination of low dose Ketamine and Parecoxib IV as preemptive multimodal analgesia in patients undergoing Laparoscopic Cholecystectomy.

Methods: This was a prospective, randomized, double blind study in 48 patients undergoing laparoscopic cholecystectomy. The study population was divided into two groups. Group I: treatment regimen of Injection (Inj.) Ketamine 0.3mg/kg IV plus Inj. Parecoxib 40mg IV. Group II: treatment regimen of Inj. Ketamine 0.3mg/kg IV plus saline. The treatment was given as single dose pre-operative. Inj. Fentanyl 0.5µg/kg was used as the rescue medication during the surgery and post-opertively. Total (intra-op and post-op) opioid, time for first opioid administration wasdetermined. Pain was assessed using Visual Analyzed Scale(VAS) and wasdetermined at 1 hour (hr.), 2 hr., 4 hr., and every 4 hr. interval till 24 hours after the surgery.

Results: As compared to Group II, Group I patients were administeredsignificantly lower dose of opioid(0.16 ± 0.26 versus 0.37 ± 0.47µg/kg P= 0.032) during the surgery. Similarly, time to rescue medication post-operativewas significantly more in Group I patients as compared to Group II (68.1 ± 41.1 versus 20.1 ± 16.1 minutes P <0.001). In post-op, total opioidrequirement was lower in Group I versus Group II patients (7.9 ± 4.1 vs 17.1 ± 6.1 µg/kg P < 0.001).

Conclusion: Multimodal analgesia regimen using combination of two different groups of analgesics (Ketamine and Parecoxib)was found to be more effective than single analgesic in reducing pain in the post-op laparoscopic cholecystectomy patients.