The Efface of Ketamine vs. Lidocaine in the Management of Pain After Laparoscopic Cholecystectomy

Effective postoperative pain management is essential for promoting patient recovery, reducing stress response, and improving overall outcomes following laparoscopic cholecystectomy. This prospective interventional study was conducted at Department of Anesthesiology at Liaquat National Hospital and Medical College to compare the analgesic efficacy of intravenous ketamine and lidocaine in managing postoperative pain among patients undergoing elective laparoscopic cholecystectomy.

A total of 76 ASA grade I and II patients with uncomplicated symptomatic gallstone disease were enrolled after obtaining written informed consent and ethical approval. Using a sealed-envelope randomization method, patients were divided into two equal groups: Group K (n=38) received ketamine, and Group L (n=38) received lidocaine. The study followed a double-blinded, placebo-controlled design to ensure unbiased assessment. Patients with ASA grade III-V, chronic pain, psychiatric illness, pregnancy or lactation, major hepatic, renal, or cardiovascular dysfunction, or a recent history of opioid or NSAID use were excluded.

All participants underwent standard preoperative preparation, including overnight fasting and pre-anesthetic evaluation. General anesthesia was induced with propofol and atracurium and maintained with isoflurane. Standard intraoperative monitoring of pulse rate, blood pressure, ECG, SpO₂, and end-tidal CO₂ was performed. Following surgery, residual neuromuscular blockade was reversed with neostigmine. All patients received intravenous diclofenac sodium every 8 hours for baseline analgesia and ondansetron to prevent postoperative nausea and vomiting.

Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Patients who reported pain received intravenous Kinz 5 mg as rescue analgesia, with timing recorded by nursing staff.

This study provided valuable insight into the comparative analgesic effects of ketamine and lidocaine for postoperative pain control following laparoscopic cholecystectomy, emphasizing their potential role in multimodal analgesia protocols to enhance patient comfort and recovery.

Inclusion criteria

• Adults aged 18-65 years.

ASA physical status I-II.

Elective laparoscopic cholecystectomy planned under general anesthesia.

Normal baseline renal, hepatic, and coagulation profile.

Able to give informed consent and communicate pain scores.

Negative pregnancy test for women of childbearing age.

Exclusion criteria

• ASA III-V patients.

Allergy or hypersensitivity to ketamine, lidocaine, or related drugs.

History of psychiatric illness or substance abuse.

Chronic use of opioids, benzodiazepines, or MAO inhibitors.

Pregnant or breastfeeding women.

Chronic pain disorders or use of analgesics within 7 days pre-op.

Major hepatic, renal, or cardiovascular dysfunction.

History of myopathy or seizure disorders.

Patients with atrioventricular block or on calcium-channel blockers.

Conversion to open cholecystectomy during surgery.

Inability to understand or report pain postoperatively.