Spermatic cord block with ketamine as an adjuvant to bupivacaine improves postoperative analgesia for testicular sperm extraction surgery

Purpose To compare the postoperative analgesic effect of bupivacaine 0.5% plus ketamine 20 mg and bupivacaine 0.5% alone in alleviating testicular visceral pain when it is injected for spermatic cord block in testicular sperm extraction (TESE) surgery. Patients and methods A randomized, double-blind, controlled trial study including 50 American Society of Anesthesiologists I–II patients undergoing TESE surgery was performed under general anaesthesia. At the end of surgery, patients were allocated randomly to one of two groups: the ‘K’ group (n =25) received bupivacaine 0.5% plus ketamine 20mg and the ‘B’ group (n =25) received bupivacaine 0.5% alone in a total volume of 10 ml for spermatic cord block. Postoperative pain was assessed by measurement of pain-free time, which was defined as the time from regaining consciousness to the appearance of mild spontaneous testicular pain. Also, the visual analogue scale (VAS) score at 6, 9, 12 and 24 h being at rest was measured. The frequency of analgesic intake in the first 24 h was also determined and the incidence of postoperative nausea and vomiting (PONV) was recorded. Results The mean pain-free time was significantly higher in the K group than the B group [302 (48) vs. 225 (27) min, P= 0.000]. The mean VAS score was significantly lower at 9 h postoperatively in the K group compared with the B group (P= 0.017). Although the mean VAS scores were lower at 6, 12 and 24 h in the K group, there were no statistically significant differences between the groups (P = 0.1, 0.186 and 0.086, respectively). Differences in the frequency of analgesic intake between the two groups were not statistically significant. There was no statistically significant difference between the groups in PONV. ConclusionThe addition of ketamine (20 mg) as an adjuvant to bupivacaine for spermatic cord block is a good option for postoperative pain control as it prolongs pain-free time and lowers VAS scores after TESE surgery, with no added risk of PONV.