Tailoring perioperative analgesia: Selecting ketamine or dexmedetomidine based on patient-specific factors

Ketamine and dexmedetomidine are widely used non-opioid agents for perioperative analgesia and sedation, each with distinct mechanisms and side effect profiles. Dexmedetomidine, an α2-adrenergic agonist, is preferred in patients with hepatic dysfunction due to its stable sedation and lower risk of delirium, though it may cause side effects such as bradycardia and hypotension. Ketamine, a non-competitive N-methyl-D-aspartate receptor antagonist, increases heart rate and blood pressure via catecholamine release and provides additional benefits such as anti-inflammatory, neuroprotective, and antidepressant properties. Although both agents have overlapping clinical roles, selection should be guided by patient comorbidities, including cardiac, hepatic, and neurological conditions. This review summarizes current evidence to support individualized decision-making in postoperative pain management.