Suppressing Postoperative Inflammation with Intravenous Ketamine as an Adjunct in Epidural Hysterectomy: A Clinical Study of C-Reactive Protein and Neutrophil–Lymphocyte Ratio

Rafly Suwandhi Wahid; Muh. Ramli Ahmad; Haizah Nurdin; A. Husni Tanra; Andi Muhammad  Takdir Musba; Charles Wijaya Tan

doi:10.18502/aacc.v12i3.21309

Rafly Suwandhi Wahid Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Muh. Ramli Ahmad Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Haizah Nurdin Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
A. Husni Tanra Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Andi Muhammad Takdir Musba Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Charles Wijaya Tan Department of Anesthesiology and Intensive Care, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.

DOI: https://doi.org/10.18502/aacc.v12i3.21309

Keywords: Hysterectomy; Ketamine; C-reactive protein; Inflammation; Epidural anesthesia; Pain management

Abstract

Background: Hysterectomy often triggers a systemic inflammatory response, increasing biomarkers like C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR), which can delay recovery and raise complication risks. Ketamine, a common anesthetic, possesses anti-inflammatory properties that may modulate this postoperative response. This study aimed to further examine the effects of ketamine on CRP and NLR levels in patients undergoing hysterectomy.

Methods: This double-blind randomized clinical trial included 28 adult female patients (ASA I–II) undergoing elective abdominal hysterectomy under epidural anesthesia. Patients were randomized to receive either 0.5 mg/kg intravenous ketamine (intervention group) or no ketamine (control group). Serum CRP and NLR were measured preoperatively and at 8 and 24 hours postoperatively. The visual analog scale was used to evaluate pain level, data were processed with the appropriate statistical test, and a p-value < 0.05 is considered significant.

Results: Our study discovers that intravenous ketamine reduced postoperative inflammatory markers significantly. Postoperative measurements at 8 and 24 ours proved that the ketamine group had lower CRP and NLR levels significantly (p<0.05). Patients receiving ketamine showed a non-significant reduction in VAS pain scores compared with controls. No participant in either group needed additional opioids for pain control.

Conclusion: Intravenous ketamine decreased postoperative inflammatory response significantly in hysterectomy patients receiving epidural anesthesia, as proved by lower CRP and NLR. Ketamine seemed to improve patient comfort by lowering pain intensity. Combining epidural anesthesia with ketamine may be a viable strategy to suppress inflammation and enhance recovery after hysterectomy.