Intraperitoneal Ketamine Versus Fentanyl as Adjuvants to Bupivacaine in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the standard surgical treatment for gallbladder stones; however, the origin of pain after LC is multifactorial and complex in nature. Pain arising from incision sites is parietal pain, whereas pain from the gall bladder bed is mainly visceral in nature, and shoulder pain is mainly referred owing to the residual carbon dioxide irritating the diaphragm. Intraperitoneal administration of local anesthetics has been shown to improve postoperative pain control and reduce the need for systemic analgesics. The addition of adjuvant agents such as fentanyl or ketamine may further enhance analgesic efficacy. This randomized double-blind study aims to compare the effectiveness of intraperitoneal ketamine versus fentanyl as adjuvants to bupivacaine in reducing postoperative pain and analgesic requirements following laparoscopic cholecystectomy.

Inclusion Criteria: * Patients of age 20-50 years * Patients of either gender * Patients planned to undergo elective LC. * Patients have I-II of the American Society of Anaesthesiologists (ASA) Exclusion Criteria: * Patient's refusal. * body mass index (BMI) ≥40 kg/m2. * History of hypersensitivity to the drugs being evaluated * Inability to comprehend postoperatively the pain assessment scale/neuropsychiatric disorders. * chronic use of opioids and opioid addiction * Patients with acute cholecystitis or converted to open surgery. * Carcinoma of gall bladder * Pregnant female * Bleeding disorders