Adding Ketamine to Xylocaine and Epinephrine in Local Infiltration for Rhinoplasty, Postoperative Analgesia and Side Effects

Background: Rhinoplasty is considered a surgical technique used to repair various nose deformities. This is one of the most challenging procedures in face aestheticsurgery. It is performed under general anesthetic, and often particular areas of the nose are infiltrated with 2% xylocaine and epinephrine to induce vasoconstriction, reduce surgical bleeding, and provide analgesia.
Objectives: The aim of the work was to determine the effect of combining ketamine with xylocaine and epinephrine in local infiltration.
Patients and methods: This prospective randomized study included a total of 44 cases distributed into two equal groups (22 each); the xylocaine - epinephrine (XE) group where the local infiltrationwas done by xylocaine and epinephrine. The second group xylocaine – epinephrine - ketamine (K) group includes the remaining patients in whom the local infiltration was done by xylocaine, epinephrine andketamine.Heart rate, blood pressure, visual analogue score (VAS), and morphine consumption were recorded.
Results: When group K was compared to group XE at 1, 2 hours post-operatively, the VAS was substantially lower.In group K the period for the initial request for analgesia (3.30±1.04h) was longer than in group XE (2.14±0.94h).A statistically significant reduction of the morphine requirement was seen in group K (7.0±3.3 mg), in comparison to group XE (10.0±3.19 mg) during the first post-surgical 24 hours.
Conclusion: It could be concluded that adding ketamine to xylocaine-epinephrine local infiltration for rhinoplasty lowered post-operative pain ratings, delayed the initial request for analgesia, and decreased overall analgesic intake in the first 24 hours post-operatively without causing severe adverse effects.