Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair

摘要

Objectives We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Methods Sixty patients were randomly allocated into two groups ( n =30), Group B received infra-orbital nerve block with 2mL of 0.25% Bupivacaine and Group BK received 0.5mg.kg ?1 Ketamine for each side added to 1mL of 0.5% Bupivacaine solution diluted up to 2mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Results Patients in Group BK showed lower postoperative FLACC scores during all recorded time points ( p <0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia ( p <0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67±45.67 vs. 240.0±0.0mg, p <0.04). The time to first oral intake was significantly reduced in Group BK (87.67±15.41 vs. 27.33±8.68min, p <0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45min (0.86±0.11 vs. 0.46±0.16, p <0.04) and in the first hour (h) postoperatively (1.40±0.17 vs. 0.67±0.14, p <0.003). Higher parent satisfaction scores were recorded in Group BK ( p <0.04) without significant adverse effects. Conclusions The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.