Comparison of the effect of combination of dexamethasone, ketamine, and fentanyl with combination of metoclopramide, ketamine, and fentanyl on postoperative pain in patients undergoing laparoscopic cholecystectomy

Abstract

Background: Pain after laparoscopic cholecystectomy is a complex physiologic reaction which can be associated with severe complications in various organs. In this study, we aimed to compare the effects of combination of dexamethasone, fentanyl, and ketamine with combination of metoclopramide, fentanyl, and ketamine on postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods: In this randomized, double-blind clinical trial study, 96 patients undergoing laparoscopic cholecystectomy aged 18-80 years were randomly allocated to three groups. Group 1 received dexamethasone (0.15 mg/kg), ketamine (0.3 mg/kg), and fentanyl (0.5 μg/kg); group 2 received metoclopramide (10 mg), ketamine (0.3 mg/kg), and fentanyl (0.5 μg/kg); and group 3 received only anesthetic induction drugs. The amount of pain and nausea were measured using the visual analog scale (VAS), as well as the frequency of vomiting and the amount of anti-nausea and drug administered at 2, 6, 12, and 24 hours after surgery. Findings: Mean pain score at 2, 6, 12, and 24 hours after surgery was significantly lower in group 1 than other groups (P < 0.05). Postoperative consumption of opioid at 2 and 6 hours after surgery was significantly lower in group 1 than other groups (P < 0.05). The mean score of nausea and anti-emetic consumption were significantly lower in group 2 than other groups (P < 0.05). Conclusion: The combination of three drugs, dexamethasone, ketamine, and fentanyl significantly reduced postoperative pain in patients undergoing laparoscopic cholecystectomy, whereas this effect was only partially attained with the combination of three drugs, metoclopramide, ketamine, and fentanyl. Both combinations of the drugs significantly reduced postoperative nausea and vomiting. © 2018, Isfahan University of Medical Sciences(IUMS). All rights reserved.