Analgesic Effectiveness Of Intravenous Ketamine Versus Fentanyl In Patients With Proximal Femur Fracture: A Comparative Study

Abstract

Introduction: Positioning patients with femur fracture for subarachnoid block (SAB) is associated with excruciating pain. Thus, intravenous (IV) analgesic like ketamine and fentanyl can alleviate pain. Objective: To compare the analgesic effectiveness of IV ketamine and fentanyl in reducing pain associated with positioning for SAB.

Methodology: This prospective comparative study was conducted in operation theatre of B P Koirala Institute of health sciences from June 2020 to May 2021. We enrolled 60 patients into two groups (allocation ratio 1:1) to receive either 0.3mg/ kg ketamine (n=30) or 1.5mcg/kg fentanyl (n=30) using randomized sampling technique. Numeric rating scale for pain (0-10) was used for pain assessment before and after study drug administration. Data was analysed using Statistical Package for Social Science software. Student’s t-test and Mann-Whitney U test were used for normal and non-normal data, respectively, while categorical data was assessed using chi-square or Fisher’s exact test. A p-value < 0.05 was considered statistically significant.

Results: The ketamine group showed better analgesia, with lower pain scores at rest 1 [1-2] vs [1-2],(p=0.006) and motion 3 [3-3] vs 3[3-4], (p=0.04). The ketamine group required fewer attempts for successful spinal needle placement (p=0.010) with better anaesthetist satisfaction (p<0.001). Ketamine caused hypertension in 21(35%) and delirium 5(8.3%), while fentanyl caused hypotension 8(13.3%), bradycardia 3(5%), and desaturation 3(5%) patients.

Conclusion: Ketamine provided superior analgesia, with lower pain scores. It also resulted in fewer attempts for successful spinal needle placement and higher anaesthetist satisfaction.