A COMPARATIVE STUDY OF EFFICACY OF INTRAVENOUS LOXICARD VERSUS KETAMINE INFUSION FOR PERIOPERATIVE OPIOID-SPARING ANALGESIA IN PATIENTS UNDERGOING ELECTIVE SPINE SURGERY: A RANDOMIZED CONTROLLED TRIAL
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Keywords
Lidocaine, Ketamine, Analgesia, Spine, Pain, Postoperative, Analgesics, Opioid, Randomized Controlled Trial as Topic (MeSH terms)
Abstract
Background: Elective spine surgery causes moderate-to-severe postoperative pain. Opioids remain the mainstay of analgesia but carry risks of respiratory depression, hypotension, sedation, nausea, vomiting and ileus. Non-opioid adjuncts such as intravenous lidocaine (Loxicard) and ketamine are used in opioid-sparing multimodal analgesia.
Objective: To compare intraoperative Loxicard versus ketamine infusion, against saline control, for perioperative opioid consumption and pain severity in elective spine surgery, and to assess haemodynamics, side effects and satisfaction.
Methods: In this prospective, randomized, three-arm study, 93 of 100 assessed patients were randomized 1:1:1 to Loxicard (L, 1.5 mg/kg loading and maintenance), Ketamine (K, 0.2 mg/kg loading and maintenance), or saline control (CG), 31 per group. Heart rate and mean arterial pressure were recorded at baseline and pre-specified intervals. Primary outcome was perioperative rescue opioid consumption; secondary outcomes were haemodynamics, side effects and satisfaction. Continuous variables were analysed by one-way ANOVA, categorical variables by chi-square test (SPSS v21.0); p<0.05 was significant.
Results: All 93 randomized patients completed the study. Mean rescue opioid consumption was lowest in Group L (7.50±5.38), intermediate in Group K (10.20±6.30), and highest in Group CG (14.30±7.10) (ANOVA p<0.0001). Loxicard differed significantly from ketamine (mean difference −2.7, p=0.041) and both drugs differed from saline (both p<0.0001). Baseline HR and MAP were comparable across groups (p=0.727, p=0.136), but HR and MAP were significantly lower in Groups L and K than CG from the earliest recorded time point onward (p<0.05), with Loxicard showing the greatest attenuation.
Conclusion: Both Loxicard and ketamine infusion reduced perioperative opioid consumption and attenuated haemodynamic stress responses versus saline, with Loxicard showing a marginally greater effect. Both are promising opioid-sparing multimodal analgesic adjuncts for spine surgery; data on pain scores, adverse effects, satisfaction and baseline demographics were unavailable in the source material and are required from the authors before the findings can be considered complete.
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