KYAMC Journal Vol. 12, No. 1, April 2021 Original Article Effectiveness of Pre-Operative Subcutaneous Infiltration of Ketamine for Post-Operative Analgesia and Haemodynamic Attenuation Md. Pervez Rahman 1 , A.B.M ShafiulAnam 2 , Md. Rafiqul Islam 3 , Md. Miraj Hossain 4 , Md. Muzibur Rahman 5 , Rahena khatun 6 . Introduction Post-operative pain has the potential for significant adverse effects on the physiology and can also drown the patient into psychological suffering. The source and degree of nociceptive stimulation differ among individuals and surgeries and hence multimodal analgesic approaches have been encouraged for pain relief. 1 Adequate pain control is essential in immediate post-operative period. Different methods are being used to provide pain management but none of these is completely effective. Regional blocks are becoming more popular then systemic opioids in all age groups due to efficacy and safety of agents used. 2 The advantage of post-operative analgesia for procedures with small incisions such as herniotomy and herniorrhaphy is well-known. 2 Abstract Background: Ketamine is a noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptor which plays an important role in pain modulation. It decreases acute postoperative pain by inhibiting C fiber activity. Objective: Purpose of this study was to evaluate the effectiveness of preoperative subcutaneous infiltration of ketamine for postoperative analgesia and haemodynamic attenuation. Materials and Methods: This Randomized controlled trial study was conducted among the patients with ASA (Ameracin Society of Anaesthesiologist) grade I & II, planned for major abdominal surgery with upper midline incision. Total 60 patients were selected and allocated into two groups, 30 in each- group A & B. Group A - Patients received subcuteneous wound infiltration with ketamine. Group B - Patients given subcuteneous wound infiltration with bupivacaine. Then haemodynamic status and patient outcome was assessed at different point of time. Results: There was no significant difference between groups in respect of demographic and ASA status. Mean age was found to 38.7±8.53 years. In Group A, 63.3% were ASA I and 36.7% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory analgesia can be acheived by subcuteneous wound infiltration with ketamine (in Group-A).The Mean verbal pain score was 5.2±0.47 and 7.4±0.68 in group A & group B respectively. The difference was statistically significant (p<0.05). After 2hrs, mean sedation was found 4.38±0.57 score in group A, but in group B score is reduced and found 3.52±0.27. Mean difference was statistically significant (p<0.05) between two groups. Conclusion: Surgical site infiltration of ketamine is a promising analgesic method in reduction of postoperative pain with minimal sedation and adverse effects. There was significantly prolonged duration of analgesia and better outcome. Key words: Subcutaneous Infiltration of Ketamine, Bupivacaine, Postoperative Analgesia, Haemodynamic Status. Date of received: 05.10.2020 Date of acceptance: 25.02.2021 KYAMC Journal 2021;12(1): 26-31. DOI: https://doi.org/10.3329/kyamcj.v12i1.53364 1. Assistant Professor, Department of Anaesthesiology, Khwaja YunusAli Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. 2. Assistant Professor, Department of Anaesthesiology, KhwajaYunus Ali Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. 3. Associate Professor, Department of Anaesthesiology, KhwajaYunus Ali Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. 4. Assistant Professor, Department of Anaesthesiology, KhwajaYunus Ali Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. 5. Professor, HOD of Anaesthesiology, KhwajaYunus Ali Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. 6. Associate Professor, Department of Anaesthesiology, KhwajaYunus Ali Medical College & Hospital, Enayetpur, Sirajganj Bangladesh. Correspondence: Dr. Pervez Rahman, Assistant Professor, Department of Anaesthesiology, Khwaja Yunus Ali Medical Collage & Hospital, Enayetpur, Sirajganj, Bangladesh. Mobile: 01755-615306, E-mail: dr.md.pervez@gmail.com 26