Ketamine-Based Anesthesia for Orthopaedic and Trauma Surgery in a Regional Trauma Centre: A Pragmatic Service Delivery Model

Abstract

Background: Limited access to main operating theatres and shortages of anaesthesia personnel remain major barriers to timely orthopaedic and trauma care in low- and middle-income countries (LMICs). In such settings, ketamine is an attractive anaesthetic option because it provides dissociative anaesthesia and analgesia while generally preserving spontaneous ventilation and airway reflexes. This study reports a five-year institutional experience of ketamine-based anaesthesia for orthopaedic and trauma surgery in a regional trauma centre and evaluates its clinical safety, feasibility, and service-delivery relevance. Objectives: The objectives are: 1) To evaluate the clinical safety, feasibility, and service delivery impact of ketamine-based anesthesia for orthopaedic and trauma surgery in a regional trauma centre over a five-year period. 2) To describe patient clinical profiles and assess anesthesia-related adverse events and perioperative complications. 3) To evaluate the procedural success rate and postoperative recovery characteristics following ketamine-assisted orthopaedic and trauma surgeries. Methods: This retrospective observational study included haemodynamically stable or adequately resuscitated patients who underwent selected orthopaedic and musculoskeletal trauma procedures under ketamine-based anaesthesia between January 2021 and December 2025. Eligibility criteria, monitoring standards, anaesthetic workflow, adjunct medication use, and complication-management pathways were standardized institutionally. Primary outcomes were procedural success, perioperative adverse events, recovery characteristics, and selected service-delivery indicators. Descriptive statistics were used, and exact 95% confidence intervals (CIs) were calculated for major event rates. Results: Of 1728 orthopaedic and trauma procedures performed during the study period, 1207 (69.8%) were completed under ketamine-based anaesthesia. Patients ranged from 3 to 75 years; 861 (71.3%) were male and 886 (73.4%) were emergency trauma cases. External fixation with or without wound debridement was the commonest procedure (47.1%). Procedural success, defined as completion of the planned procedure without conversion to general anaesthesia, unplanned airway intervention, or abandonment, was 100% (1207/1207; 95% CI 99.7 - 100). No anaesthesia-related mortality occurred (0/1207; 95% CI 0.0 - 0.31). The commonest perioperative adverse event was transient hypertension in 69 patients (5.7%; 95% CI 4.5 - 7.2), followed by nausea/vomiting in 19 (1.6%; 95% CI 1.0 - 2.4), transient desaturation in 7 (0.6%; 95% CI 0.23 - 1.19), delayed recovery in 7 (0.6%; 95% CI 0.23 - 1.19), and hypersalivation in 3 (0.25%; 95% CI 0.05 - 0.72). There were no emergence reactions and no unplanned airway interventions. Most patients recovered sufficiently and transferred to the wards within 20 to 45 minutes, and selected day-case patients were discharged the same day. Conc lusion: Ketamine-based anaesthesia was a safe, feasible, and efficient approach for selected orthopaedic and trauma procedures in this regional trauma centre. Within a structured service-delivery model that includes careful case selection, minimum monitoring standards, and emergency readiness, ketamine can expand access to timely trauma surgery in resource-constrained settings.