Introduction: Postoperative complications such as respiratory depression, nausea, and vomiting are particularly distressing for morbidly obese patients and pose significant challenges for anesthesiologists. This study aimed to evaluate the use of non-opioid analgesics to reduce opioid-related complications during recovery. We compared the analgesic effects of intravenous ketamine infusion and opioids in patients undergoing laparoscopic sleeve gastrectomy.
Methods: In this double-blind, randomized clinical trial, 66 morbidly obese patients (BMI ≥ 40 kg/m²) without significant comorbidities, referred to Baqiyatallah Hospital for laparoscopic sleeve gastrectomy from April 2022 to April 2023, were included. Patients were randomized into two groups of 33: the ketamine group received 0.5 mg/kg intravenous ketamine before positioning, followed by 0.5 mg/kg/hour infusion, while the opioid group received 10 mg intravenous morphine sulfate before positioning, followed by remifentanil infusion (0.25 µg/kg/minute) until the end of surgery.
Results: The mean morphine consumption during recovery was 2.3 mg in the ketamine group and 2.4 mg in the opioid group (p = 0.88). The mean VAS score during recovery was 3.725 in the ketamine group and 3.984 in the opioid group (p = 0.320). Propofol consumption was significantly lower in the opioid group (603.943 mg vs. 808.333 mg, p = 0.03). All patients in the ketamine group required trinitroglycerin (TNG) infusion for hemodynamic stability, compared to none in the opioid group. Hallucinations were significantly more frequent in the ketamine group (16.7% vs. 0%, p = 0.00).
Conclusion: In laparoscopic sleeve gastrectomy, ketamine and opioids showed no significant differences in pain scores, opioid consumption, or PONV incidence during recovery. However, propofol consumption was significantly lower in the opioid group, and hallucinations were more frequent in the ketamine group. These findings suggest that while ketamine may be a viable alternative to opioids, its side effects and higher propofol requirements warrant further investigation.