Comparative study of analgesic effect of epidural ketamine vs. epidural tramadol in patients undergoing mastectomy under thoracic epidural anesthesia

Methods
Our study included 50 female participants belonging to the 18–60-year-old age group who were epidurally anesthetized for mastectomy operation. Participants were randomly assigned to the ketamine group (epidural bupivacaine and ketamine 50 mg) (KG) and the tramadol group (epidural bupivacaine and tramadol 1 mg/kg) (TG). Pain was measured using the visual analog scale (VAS), and the consumption of rescue analgesia was recorded as well. Nausea and vomiting, sedatives, and vasopressors were recorded and compared between both groups.
Results
KG showed a decrease in VAS scores, less consumption of rescue analgesia, lesser need for antiemetic, and has demanded for more sedation in comparison with TG when observed in the post-anesthesia care unit (PACU) for 24 h postoperatively. Our study could not detect significant differences between groups among recorded demographic data, hemodynamic parameters, or the need for vasopressors.
Conclusion
Epidural ketamine provided a better analgesia and less need to rescue analgesia, less incidence of nausea and vomiting, but more sedation when compared with epidural tramadol at a dose of 1 mg/kg
Breast surgery under epidural procedure is a secure, accepted alternative to general anesthesia and can increase the outcome postoperatively with less cost. Postoperative analgesia provides a better outcome, early regain of activity with the least side effects, and early discharge. This study compares the analgesic efficacy of thoracic epidural ketamine versus thoracic epidural tramadol when added to bupivacaine at 0.5% for patients who underwent mastectomy under epidural anesthesia.