Author(s)

Fatma A. El Sherif¹, Moaaz Tohamy^1*, Mohamed A. M. Mostafa¹, Suzanne de la Adlan², Sahar Abdel-Baky Mohamed¹, Samar Mansour³, Mahmoud M. Mohammed⁴, Ahmad M. Abd El-Rahman¹

¹Anethesia, ICU, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
²Anesthesia, ICU, and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.
³Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
⁴Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

Background: Ketamine or dexmedetomidine as an adjuvant to bupivacaine in local wound infiltration attenuated postoperative stress response, especially with ketamine in patients undergoing total abdominal hysterectomy. Objectives: Compare effect of local wound infiltration with ketamine or dexmedetomidine added to bupivacaine to bupivacaine alone on inflammatory cytokine response after total abdominal hysterectomy. Methods: Sixty female patients with endometrial carcinoma underwent total abdominal hysterectomy and scheduled to receive local wound infiltration before wound closure either with one of three; 40 ml of 0.25% bupivacaine alone (C Group) or with the addition of 2 mg/kg ketamine (K Group) or 2 μg/kg dexmedetomidine (D Group). After extubation, they were followed up for postoperative interleukin 6 (IL6), IL1β, IL10, and TNF-α levels were assessed at baseline, pre-infiltration, 6, and 24 h by blood samples obtained from each patient, hemodynamic variables, analgesic profile and side effects. Results: Inflammatory cytokines response was attenuated in K and D groups, evidenced by decreased mean pro-inflammatory cytokines IL6, TNF-α, and increased anti-inflammatory IL10 at 6 and 24 h postoperatively compared to pre-infiltration levels (p ≤ 0.01) with preservation of IL1β at its preoperative level (p > 0.05). Attenuation was more in K and D groups than in the C group and was highest in the K group with decreased 1^st request, total morphine consumption without serious side effect. Conclusion: Local wound infiltration with ketamine or dexmedetomidine added to bupivacaine has a good postoperative analgesic profile and attenuated cytokines inflammatory response more than bupivacaine alone after total abdominal hysterectomy, with highest attenuation in ketamine group.

Ketamine, Dexmedetomidine, Local Infiltration, Cytokines, Hysterectomy

Sherif, F. , Tohamy, M. , A. M. Mostafa, M. , Adlan, S. , Mohamed, S. , Mansour, S. , Mohammed, M. and El-Rahman, A. (2022) Effect of Local Wound Infiltration with Ketamine versus Dexmedetomidine Added to Bupivacaine on Inflammatory Cytokines, a Randomized Clinical Trial. Open Journal of Anesthesiology, 12, 261-277. doi: 10.4236/ojanes.2022.128024.