STUDY OBJECTIVE: To compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery.
DESIGN: Prospective, randomized, double-blinded, placebo-controlled study.
SETTING: Operating rooms and postoperative recovery rooms.
PATIENTS: 120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia.
MEASUREMENTS: Patient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective.
MAIN RESULTS: The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia.
CONCLUSIONS: Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia.
BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section.
METHODS: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-µg fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively.
RESULTS: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively.
CONCLUSIONS: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.
BACKGROUND: Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants.
OBJECTIVES: Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone.
PATIENTS AND METHODS: Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups. Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients.
RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients.
CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group.
BACKGROUND: In the absence of neuraxial opiates, postoperative analgesia after caesarean delivery is limited by the duration of action of bupivacaine. This could be prolonged by the co-administration of adjuvants such as ketamine.
METHODS: Spinal anaesthesia was performed in 60 parturients using hyperbaric bupivacaine 15 mg. Patients were randomly allocated to receive a 2-mL intravenous injection of either ketamine 0.15 mg/kg (Group BK) or 0.9% saline (Group B) immediately after institution of spinal anaesthesia. Postoperative pain was assessed using a visual analogue scale and the time of first postoperative analgesic administration was noted. Postoperative analgesia was provided with intramuscular pentazocine and diclofenac, the total doses of which were recorded over 48 h.
RESULTS: The mean (SEM) time of first postoperative analgesic administration was significantly longer in Group BK (209±14.7 min) than in Group B (164±14.1 min) (P<0.001). Pain scores were significantly lower in Group BK than in Group B for 120 min after surgery (P=0.022). Patients in Group BK required significantly less diclofenac (P<0.001) and pentazocine (P<0.001) on day one after surgery. There was no difference in diclofenac (P=0.302) and pentazocine (P=0.092) consumption between the groups on the second postoperative day. The incidence of adverse effects was not different between the groups.
CONCLUSION: The use of intravenous low-dose ketamine as an adjuvant to bupivacaine for spinal anaesthesia for caesarean delivery was associated with longer postoperative analgesia and lower early postoperative analgesia consumption than bupivacaine alone.
BACKGROUND: Attenuation of central sensitization with NMDA-active drugs such as S-Ketamine may play a role in postoperative analgesia and prevention of neuropathic pain. However, during cesarean section with neuraxial block, S-Ketamine might have adverse effects on the interaction between mothers and infants, including breastfeeding.
METHODS: Women undergoing elective repeat cesarean section with subarachnoid anesthesia (0.5% hyperbaric bupivacaine 8-10 mg and sufentanil 5 μg) were enrolled in a double-blind, randomized study. Patients in the S-Ketamine group (N.=28) received i.v. midazolam 0.02 mg/kg and S-Ketamine 0.5 mg/kg i.m. bolus 10 minutes after birth followed by a 2 μg/kg/min i.v. continuous infusion for 12 h. The control group (N.=28) received placebo. Paracetamol and patient controlled analgesia with intravenous morphine were given postoperatively. Von Frey filaments were used to assess pain threshold on the inner forearm and T10-T11 dermatomes (supposed hyperalgesic area).
RESULTS: S-Ketamine reduced morphine consumption at 4-8, 8-12, and 12-24 hours after surgery (total 31%), even after its effect has ceased, suggesting an anti-hyperalgesic action. Mild side effects were observed in the S-Ketamine group one hour after delivery. All side effects were rated as light and there were no serious adverse events. Pain threshold was not significantly different between groups. S-Ketamine patients showed a trend towards reduced pain sensitivity at the T10 dermatome, which is involved by surgical damage. After three years, patients reported no differences in residual pain, dysesthetic symptoms, or duration of breast-feeding.
CONCLUSION: Preventive administration of S-Ketamine via 12-hour infusion was safe and may have anti-hyperalgesic action after cesarean section.
BACKGROUND: Ketamine is an analgesic suitable for the induction of anesthesia during Caesarean delivery. This double blind, randomized trial examined the effect of intravenous ketamine used before the induction of general anesthesia on morphine consumption, immediate and long term postoperative pain after Cesarean delivery.
METHODS: One hundred and forty term pregnant women undergoing elective Cesarean delivery were randomized into four groups (N.=35 each), placebo (0.9% normal saline), ketamine 0.25, 0.5, or 1 mg kg(-1) intravenously. In all patients 2-2.5 mg kg(-1) propofol was used for the induction of anesthesia, 0.6 mg kg(-1) rocuronium to facilitate the tracheal intubation and 50% oxygen in N2O and sevoflurane (end-tidal concentration of 1.2-1.3 %) for the maintenance of anesthesia. Postoperative analgesia was provided with intravenous morphine chloride patient-controlled analgesia (PCA) and rescue analgesia with intramuscular diclofenac sodium in the postoperative period. Apgar scores of the neonates and hemodynamic variables of the mothers were recorded during anaesthesia. Groups were compared regarding the cumulative morphine consumption and pain scores assessed with a numerical rating (0-10) scale at 2, 6, 12, 18, 24, and 48 h postoperatively. Postoperative side effects were recorded. Patients were evaluated for persistent postoperative pain at 2 weeks, 1 and 6 months, and 1 year.
RESULTS: The cumulative morphine consumption at 48 hours after the surgery was the primary outcome of the study. There was no significant difference in terms of acute pain at 2 (P=0.3), 6 (P=0.7), 12 (P=0.4), 18 (P=0.4), 24 (P=0.8), and 48 (P=0.5) hours postoperatively. Cumulative morphine consumption obtained at 2 (P=0.9), 6 (P=0.5), 12 (P=0.4), 18 (P=0.4), 24 (P=0.1), and 48 (P=0.2) hours was also similar among the groups. Prolonged postoperative pain evaluated 2 weeks (P=0.3), 1 month (P=0.7), 6 months (P=0.1) and 1 year (P=0.3) after the operation was also similar among the groups. There was no significant difference in side effects among the groups during the postoperative 48 hours. Apgar scores at 1 min (P=0.5) and 5 mins (P=0.5) were similar among the groups. Maternal intraoperative hemodynamic parameters were similar among the groups.
CONCLUSION: There was no difference regarding early and late postoperative pain and morphine consumption with ketamine at doses of 0.25, 0.5, and 1 mg kg(-1) in women undergoing Caesarean delivery under general anaesthesia, compared with the control group.
OBJECTIVES: In this study, the preemptive effect of a small dose of ketamine on postoperative wound pain and morphine consumption in patients undergoing elective cesarean section was evaluated. METHODS: In a randomized, double-blind clinical trial, 60 women with American Society of Anesthesiologists class I and II identification undergoing elective cesarean section were enrolled. In the case group, the patients received 0.5 mg/kg ketamine, and in the control group, they received isotonic saline, 5 minutes before the induction of anesthesia. Anesthesia was induced with 4 mg/kg thiopental followed by 1.5 mg/kg succinylcholine. A further neuromuscular block was achieved by using 0.2 mg/kg of atracurium. Anesthesia was maintained with nitrous oxide 50% and halothane in oxygen. The lungs were mechanically ventilated. After fetus delivery, fentanyl (2 μg/kg) and morphine (0.15 mg/kg) were given intravenously. In the postanesthesia care unit and in the ward, all patients received morphine. Pain was assessed by the Visual Analog Scales at 2, 6, 12, and 24 hours postoperatively; the amount of morphine used and side effects were recorded. RESULTS: There was no significant difference between the patients considering their operative details, homodynamic variables, side effects, and Apgar scores of their babies at first and fifth minutes. Significantly, lower amounts of morphine were used in the case group (4.8 mg ± 2.5 mg vs. 8.1 mg ± 4.2 mg) during the first 2 hours after surgery (P=0.01), but the difference was not significant during 2 to 24 hours (3.2 ± 2.2 vs. 3.1 ± 2.3). There were no statistical differences between the groups in pain 2, 6, 12, and 24 hours postoperatively. DISCUSSION: Intraoperative low-dose ketamine had no effect on morphine consumption during 2 to 24 hours after surgery. No significant differences were seen in the pain scores of the 2 groups during the study period. The preoperative administration of 0.5 mg/kg ketamine in patients undergoing cesarean section did not elicit a preemptive analgesic effect. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
BACKGROUND AND OBJECTIVES: To compare the analgesic effects of intrathecal fentanyl and low-dose intravenous ketamine as adjuvants to intrathecal bupivacaine for Caesarean section.
METHODS: Ninety elective Caesarean section patients were randomized into three groups. Spinal anaesthesia was performed with 15 mg hyperbaric bupivacaine in all groups. Ketamine (0.15 mg kg(-1)) or an equal volume of normal saline was given intravenously immediately after initiating spinal anaesthesia in the ketamine and control group, respectively. In the fentanyl group, 10 microg fentanyl was added to the intrathecal bupivacaine. Arterial pressures, heart rate values, adverse effects, the time of first request for postoperative analgesia, visual analogue pain scores, total analgesic consumptions at 24 and 48 h were recorded in all patients.
RESULTS: The time to first request for analgesia was significantly longer in the ketamine (197 min) and fentanyl (165 min) groups compared to the control group (144 min). Postoperative pain scores were significantly lower in the ketamine group than in both other groups. Although the analgesic requirements during first 24 h were significantly lower in the ketamine group, there was no significant difference between the groups during the following 24 h.
CONCLUSION: Intravenous low-dose ketamine combined with intrathecal bupivacaine for Caesarean section provides longer postoperative analgesia and lower postoperative analgesic consumption than bupivacaine alone suggesting a pre-emptive effect.
OBJECTIVE: To compare the neonatal and maternal effects of propofol and ketamine as induction agents for elective cesarean section.
DESIGN: Randomized, double-blind study.
SETTING: Inpatient Obstetrics Department of Sappasitthiprasong Ubonratchatani Hospital, Ubonratchatani province, Thailand
INTERVENTION: 2 groups of 50 patients each receiving either 2 mg/kg propofol or 1 mg/kg ketamine for the induction of anesthesia.
RESULTS: The time from the induction to cord clamping (I-C), the time from the uterine incision to cord clamping (U-C), the hemodynamic changes, sleep'quality, dream, recall, awareness, Postoperative nausea & vomiting (PONV), and Apgar scores were studied In the ketamine group Systolic Blood Pressure and Diastolic Blood Pressure rose about 10-25% of the baseline after the induction, intubation, skin incision, and cord clamping (p < 0.001) while in the propofol group only the Heart Rate rose (p < 0.036) after the induction, the intubation, the skin incision, and cord clamping. Apgar scores, the I-C time, the U-C time, the age, the weight and total amount of methergin and oxytocin were not significantly different in both groups. No incidence of awareness, nightmare and ketamine's phychomimetic side effects was found The incidence of unpleasant light sleep, dreams and PONV was low. Most patients were willing to have the same anesthetic technique for the next cesarean section (81.3% of the propofol group & 86% of the ketamine group).
CONCLUSION: Both propofol and ketamine can be used as alternative induction agents to thiopental. The addition of sevoflurane immediately after the induction, together with the use of midazolam and morphine after delivery shall prevent awareness and ketamine's phychomimetic side effects. However ketamine was cheaper and although Systolic Blood Pressure and Diastolic Blood Pressure were elevated they were within an acceptable range.
120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia.
MEASUREMENTS:
Patient characteristics, anesthetic and surgical details, Apgar scores at 1 and 5 minutes, and side effects of the study drugs were recorded. Heart rate, mean arterial pressure, oxygen saturation via pulse oximetry, tympanic temperature, severity of shivering, and degree of sedation were recorded before intrathecal injection and thereafter every 5 minutes. Patients were randomized to three groups: saline (Group C, n=30), intravenous (IV) ketamine 0.25 mg/kg (Group K-0.25, n=30), or IV ketamine 0.5 mg/kg (Group K-0.5, n=30). Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective.
MAIN RESULTS:
The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C (P = 0.001, P = 0.001, respectively). The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group. Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10, 20, 30, and 40 minutes after spinal anesthesia.
CONCLUSIONS:
Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia.
