Perioperative Nasal Administration of Ketamine Successfully Eliminates the Need for Opioid Usage in the Bariatric Patient

Introduction: Usage of opioids for pain management in bariatric surgery patients requires special attention. Administration of narcotics to the obese patient carries the risk of respiratory suppression both due to the opioids and redistribution of the anaesthetics from the adipose tissue. We would like to share our experience in nasal administration of ketamine for post operative pain management following gastric bypass.

Materials and Methods: 33 (28 Laparoscopic Gastric Bypass, 5 Laparoscopic Sleeve Gastrectomy) Patients were included in the study. Total Intravenous Anesthesia (Propofol Remifentanyl) was the preferred method of anesthesia. 10 mg’s of ketamine was administered to every patient intravenously after the cessation anestetics, prior to removal of trocars. A metered nasal spray delivering 2.5 mg’s of ketamine was utilized to administer 10 mg’s of ketamine (first dose) by the onset of pain and 10mg’s every 3 hours.

Results: The ketamine spray was effective in pain control with the onset of analgesic effect 2-3 minutes following nasal administration. No changes in oxygen saturation were seen, the patients did not experience hallucinations, and postoperative mobilization was effectively carried out every 4 hours. Only 1 patient required opiods despite nasal ketamine administration.

Conclusion: Although our series are small and our results to be confirmed by other researchers, there are increasing numbers of papers on the analgesic properties and augmenting effects of ketamine on other analgesics. We believe that ketamine may be an effective and safe way of controlling postoperative pain in the morbidly obese patient


Session: Poster

Program Number: P089

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