Comparison of the effects of two drug combinations: ropivacaine-dexmedetomidine and ropivacaine-ketamine administered subcutaneously for postoperative pain control in patients with inguinal hernia: a double-blind clinical trial.

Abstract

<h4>Introduction</h4>Postoperative pain management is a significant concern in surgery. This study aimed to compare the effects of two drug combinations, ropivacaine-dexmedetomidine and ropivacaine-ketamine, administered subcutaneously for postoperative pain control in patients undergoing inguinal hernia repair.<h4>Materials and methods</h4>In this double-blind clinical trial, 140 patients scheduled for inguinal hernia surgery using the Lichtenstein technique at Valiasr Hospital in Arak were enrolled. They were randomly allocated into two treatment groups: dexmedetomidine + ropivacaine and ketamine + ropivacaine. The first group received dexmedetomidine 1 µg/kg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. The second group received ketamine 100 mg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. In both groups, subcutaneous injections were administered at the surgical incision site, which was then marked. Pain was assessed using the Visual Analog Scale (VAS) in the recovery room and at 2, 4, 6, 12, and 24 h postoperatively by a specialized surgical assistant. Changes in heart rate, mean arterial pressure, duration of analgesia, total opioid consumption, and complications were also recorded. Data were analyzed using SPSS version 20.<h4>Results</h4>The mean pain score was significantly lower in the dexmedetomidine + ropivacaine group compared to the ketamine + ropivacaine group (P < 0.001). The mean duration of analgesia was significantly shorter in the ketamine + ropivacaine group (P = 0.001). The mean opioid consumption was significantly higher in the ketamine + ropivacaine group (P = 0.01).<h4>Conclusion</h4>Dexmedetomidine, compared to ketamine, provides superior pain reduction, prolongs analgesia duration, and decreases opioid requirements following inguinal hernia repair using the Lichtenstein technique.

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