Publication date: Available online 25 May 2019
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Johnson Cheung, Ahmad Alashi, Prosper Koto, James Brady, Benjamin Davis
Abstract
Purpose
Despite ketamine’s effectiveness as an anesthetic and known analgesic properties, the role of ketamine in post-operative pain following third molar surgery remains unclear. Therefore, this study aims to investigate if patients undergoing third molar surgery who receive a sub-anesthetic pre-operative dose of intravenous ketamine will experience less post-operative pain.
Materials and Methods
The investigators implemented a randomized, double-blinded, placebo-controlled trial. The study sample consisted of participants undergoing third molar surgery with procedural sedation anesthesia. As predictor variables, participants were randomized to receive a pre-operative intravenous dose of ketamine or placebo. The primary outcome variable was post-operative pain intensity determined by 10-point visual analogue scales (VAS) at 6-hour intervals over 48-hours. The secondary outcome variable was quantity of post-operative non-opioid and opioid consumption. Other variables include extent and difficulty of surgery performed, patient satisfaction, gender and age. Data analysis involved descriptive statistics, multivariate analysis, and regression analysis. The P-value was set at 0.05.
Results
One hundred and thirty-four participants were randomly enrolled into either the ketamine group (n=74, 55.2%) or the placebo group (n=60, 44.8%). There were no statistically significant differences in the distribution of study variables between groups. There was a small, yet statistically significant (P<0.05) difference in median pain score at 6-hours post-operatively with the ketamine group experiencing more pain. However, no further differences were detected at any post-operative time between both groups. Similar results were obtained after adjusting for age, gender, and surgical difficulty. There was no difference in the amount of post-operative non-opioid or opioid medication use between both groups.
Conclusions
This study did not find evidence that a pre-operative sub-anesthetic dose of ketamine could reduce pain following third molar surgery, nor have any effects on non-opioid or opioid analgesic consumption. Nevertheless, ketamine remains a valuable option among sedation medications for oral and maxillofacial surgeons.
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