Journal of AdvancedMedical and Dental Sciences Research

Background and Aim: Multimodal analgesia relates a balanced approach to treat post-operative pain by combining multiple therapeutic agents and regional techniques. This study was conducted to evaluate the post-operative analgesic efficacy and safety of intravenous water based diclofenac sodium with or without pre-emptive intravenous ketamine in lower limb orthopedic surgery under spinal anaesthesia. Methods: This was a prospective, randomized, comparative hospital based study. Three groups of 30 patients each, i.e., receiving diclofenac sodium with or without pre-emptive ketamine and control group were enrolled. VAS score, time of first analgesic request, duration of analgesia, total analgesic requirement in first 24h, intra-operative and post-operative hemodynamics, any side effects and complication were recorded. Results: The VAS score was significantly lower in Group DK as compared to Group NS and Group D(P=0.001) at T30min to T24h. Mean time for first analgesic request was longer in group DK (373±9.39 min), as compared to group NS (179.13±5.95min) and group D (228.30±7.97min). Total analgesic consumption in postoperative 24h was lower in group DK (1.27±0.45) as compared to group NS (2.86±0.44) and group D (1.67±0.55). No significant adverse effects were found in any group. Conclusion: Pre-emptive use of ketamine with intravenous diclofenac sodium as a part of multimodal analgesia regimen render the patient pain-free in immediate post- operative period and minimize the demand of rescue analgesic.