The comparison of postoperative analgesic effects of preemptive ketamine and fentanyl use in mastectomy operations

The aim of this study was to compare the efficacy of preemptive analgesia with fentanyl or ketamine in women undergoing mastectomy for breast cancer. Asa I-II, 47 women scheduled for mastectomy were included in the study. For all patients, anesthesia was induced with thiopentale, vecuronium and maintained with o2: n2o (30: 70) + isoflurane. Heart rate (hr), mean arterial pressure (map), peripheral o2 saturation (spo2) were monitored. After the induction of anesthesia, the patients were randomly divided in three groups: group k (n=16) received 1 mg/kg ketamine, while group f (n=16) received 1 µg/kg fentanyl before the skin incisions and after excision of the specimens. Group p received isotonic saline at sametimes. No other analgesic drugs were used intraoperatively. Hr, map, extubation times, emergency times, respiration rate, spo2, side effects were recorded and postoperative pain was evaluated by visual analogue scale (vas; 0-10) and verbal rating scale (vrs) in the recovery room at full emergence (0), 1st, 2nd, 4th, 12th and 24th hours. Postoperative analgesic requirements (meperidine) were recorded. The comments of anaesthesiologist and patients about postoperative period were also evaluated. There were no differences in weight, age, emergence times, extubation times. Hemodynamic and respiratory parameters, vas and vrs scores and meperidine requirements were similar at all times between the group k and f. The increase of postoperative nausea and vomiting in group f was significantly higher than group p but was similar between group k and p and group k and f (p<0.05). As a conclusion, both ketamine and fentanyl have premptive effects in patients undergoing mastectomy but we think that analgesic effects are probably due to administirating ketamine and fentanyl both before surgical incision and before wound closure.