The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

• Published in: The Scientific World Journal
• Main Authors: Alireza Kazemeini, Mojgan Rahimi, Mohammad Sadegh Fazeli, Seyedeh Adeleh Mirjafari, Hamid Ghaderi, Kamal Fani, Mohammad Forozeshfard, Marzieh Matin
• Format: Article
• Language: English
• Published: Wiley 2014-01-01
• Online Access: http://dx.doi.org/10.1155/2014/424152
• ISSN: 2356-6140; 1537-744X

Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P<0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P<0.05). Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.