Tailoring perioperative analgesia: Selecting ketamine or dexmedetomidine based on patient-specific factors-ZENTIME PUBLISHING CORPORATION LIMITED

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

Edward Sun¹, Meikun Wang², Zongda He³, Mingyue Li⁴, Jingping Wang⁵

¹University of British Columbia, Vancouver, Canada BC V6T 1Z4. ²Department of Anesthesia, First Hospital, Jilin University, Changchun 130021, Jilin Province, China.³King' s College, London, UK WC2R 2LS. ⁴Department of Anesthesia, Second Hospital, Jilin University, Changchun 130021, Jilin Province, China. ⁵Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114, MA, USA.

Address correspondence to: Jingping Wang, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston 02114, MA, USA. Tel: +86-617-643- 2729. E-mail: jwang23@MGH.Harvard.edu.

DOI: https://doi.org/10.61189/577707zkzsmw

Received July 5, 2025; Accepted September 5, 2025; Published December 31, 2025

Highlights

● Ketamine and dexmedetomidine offer effective non-opioid perioperative analgesia, each with distinct cardiovas-cular, hepatic, and neurological profiles.

● Dexmedetomidine provides stable sedation and potential neuroprotection, making it particularly suitable for pa-tients with hepatic dysfunction and those undergoing neurosurgery.

● Ketamine helps maintain hemodynamic stability and possesses anti-inflammatory and anti-depressant proper-ties, making it beneficial for high-risk or unstable patients.

● Agent selection should be tailored to individual comorbidities, with combination therapy offering potential syner-gistic advantages.

Abstract

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.

Keywords: Ketamine, dexmedetomidine, pain management

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