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Intraperitoneal ketamine attenuates the inflammatory reactivity associated with pneumoperitoneum

Background Laparoscopic surgery is a common procedure that has replaced many types of open surgeries. Ketamine is an anesthetic drug that has immunomodulatory and anti-inflammatory effects. It results in ‘homeostatic regulation’ of the acute inflammatory reaction. Aim The primary outcome was to evaluate the anti-inflammatory effect of intraperitoneal instillation of low-dose ketamine (0.5 mg/kg) in laparoscopic pneumoperitoneum. The secondary outcome was to evaluate its analgesic effect. Patients and methods This study was carried out on 46 patients aged 26–46 years of ASA grade I–II. All patients were scheduled for laparoscopic cholecystectomy. The patients’ history, clinical examination, and laboratory investigations were carried out on the preoperative day. Patients were randomly allocated to one of two groups: the ketamine intraperitoneal (KIP) group (n=23 patients), in which 0.5 mg/kg ketamine diluted in 30 ml normal saline was instilled intraperitoneally; and the saline intraperitoneal (SIP) group (n=23 patients), in which 30 ml of normal saline was instilled intraperitoneally. The following parameters were recorded: time to extubation, time to first request for analgesia, numerical rating scale for pain, the total dose of pethidine postoperatively, and biochemical assay for interleukin 6 (IL-6). Results No patients complained of pain in the KIP group compared with the SIP group. The time to first analgesic request postoperatively was significant longer in the KIP group than in the SIP group (P<0.013). Patients in the KIP group required a lower dose of pethidine in the first 24 h postoperatively compared with patients in the SIP group (P<0.001). The postoperative serum IL-6 levels were significantly lower in the KIP group compared with the levels in the SIP group (P<0.001). Conclusion This study suggests that low-dose ketamine (0.5 mg/kg) attenuates the increase of IL-6, which is a biomarker of inflammatory activation associated with pneumoperitoneum.