Postoperative Analgesic Efficacy of Dexmedetomidinein Combined with Ketamine versus Dexmedetomidine Monotherapy in Vaginal Hysterectomy under Spinal Anesthesia: Evidence-Based Review

Abstract

Effective postoperative pain control following vaginal hysterectomy remains essential for early mobilization, enhanced recovery, and improved overall patient outcomes. Although spinal anesthesia provides adequate intraoperative analgesia, pain commonly emerges after regression of the block, necessitating additional strategies. Dexmedetomidine, a selective α2-adrenergic agonist, offers sedative and analgesic properties without significant respiratory depression, while ketamine, an NMDA receptor antagonist, provides potent analgesia with notable opioid-sparing effects. Their combined use has attracted increasing interest within multimodal analgesia approaches. This review evaluates the postoperative analgesic efficacy of intravenous dexmedetomidine–ketamine combination compared with dexmedetomidine alone in patients undergoing vaginal hysterectomy under spinal anesthesia.