Low-dose ketamine infusion for labor analgesia: A double-blind, randomized, placebo controlled clinical trial

Joel, Sam; Joselyn, Anita Shirley; Cherian, Verghese T.; Nandhakumar, Amar; Raju, Nithin; Kaliaperumal, Ilamurugu

doi:10.4103/1658-354x.125897

Cited by 23 publications

(15 citation statements)

References 11 publications

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“…Currently, ketamine is used frequently in surgical procedures for inducing anesthesia in neonates, children, animals, and soldiers on the battlefield [1]. Ketamine has also been administered to pregnant women during cesarean delivery [3] and for labor analgesia [4]. Ketamine is both lipid and water soluble [5], thus enabling it to cross the blood brain barrier [6].…”

Section: Introductionmentioning

confidence: 99%

Ketamine Attenuates the ACTH Response to Hypoxia in Late-Gestation Ovine Fetus

Chang

Wood²

2015

Neonatology

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Background: Ketamine, a noncompetitive N-Methyl-D-aspartate (NMDA) receptor antagonist, is a commonly used dissociative anesthetic in neonatology. We have proposed that ketamine reduces fetal stress responsiveness to stimuli that involve reduced oxygen supply to the fetal brain. Previously, we have shown that ketamine inhibits plasma ACTH levels in late-gestation fetal sheep subjected to brachiocephalic artery occlusion (BCO), an ischemic hypoxia model that might activate some of the same direct and reflex responses as hypoxia. Objectives: We performed the current study to test the hypothesis that ketamine pretreatment will reduce fetal ACTH responses to hypoxic hypoxia (HH). Methods: Fetal sheep were chronically catheterized at least 5 days prior to study. Ketamine (3 mg/kg) was administered intravenously to the fetus 10 min prior to normoxia or a period of hypoxia induced by administration of nitrogen gas to the maternal trachea for 30 min. Results: Hypoxia significantly increased both fetal ACTH and cortisol levels in both the control and ketamine groups (p < 0.0005, interaction effect of time·stimulus in two-way ANOVA), and the ACTH response was blunted by ketamine (p < 0.005). Conclusions: Ketamine reduced fetal ACTH responses to HH, possibly due to antagonism of the NMDA receptors in the fetal brain. Interestingly, in contrast to the responses to BCO, ACTH responses to HH were only partially inhibited, suggesting that multiple neurotransmitter pathways mediate the ACTH response to HH.

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Section: Introductionmentioning

confidence: 99%

Ketamine Attenuates the ACTH Response to Hypoxia in Late-Gestation Ovine Fetus

Chang

Wood²

2015

Neonatology

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“…The rate of operative vaginal delivery was found to be much higher as compared to the present study. 12 There was no statistically significant difference in the Apgar score between the study group and the control group and all the newborns in both groups had satisfactory Apgar scores. Similar findings were observed by Daftary et al and Kshirsagar et al 2,14 In this study, no maternal complications were observed immediately, 24 hours and 1 week after giving PNB.…”

Section: Discussionmentioning

confidence: 71%

“…10,11 Similarly, Joel et al used ketamine infusion to maintain pain relief throughout the labor till the delivery occurred. 12 In this study, second stage labor analgesia has been specifically studied because it is the stage of labor when women experience most severe pain and anesthetists are not available in resourcepoor setups to provide epidural analgesia.…”

Section: Discussionmentioning

confidence: 99%

Quest for Labor Analgesia in Second Stage in Resource Poor Setup

Das¹,

Khatuja²,

Mittal³

2018

Journal of South Asian Federation of Obstetrics and Gynaecology

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194Aim: To assess the analgesic effect of pudendal nerve block (PNB) as labor analgesia in the second stage of labor, its effect on the duration of the second stage and to assess any adverse maternal and fetal outcome. Materials and methods:The prospective, randomized, casecontrol study (parallel group trial) was conducted with a total of 110 parturient women. They were randomly allocated to either study group (n = 55) or control group (n = 55). The study was performed after the approval of the institutional ethical committee. All the women recruited for the study were given first stage analgesia. The pain was assessed using the verbal rating scale. In the second stage of labor, the women in the study group were given transvaginal PNB (5 mL of 1% Lignocaine + 5 mL of 0.25% bupivacaine) bilaterally, whereas, in control group, no added analgesia was given. Statistical analysis:Quantitative data were compared using the unpaired t-test and qualitative data was compared using chi square test. p ≤ 0.05 has been taken as the level of statistical significance. The data were analyzed by Statistical Package for the Social Sciences (SPSS) statistical software version 17.0.Results: It was observed that in the second stage of labor, Pudendal Nerve Block produced pain relief in 98.2% women, out of which 14.6% had excellent pain relief and 52.7% had moderate pain relief. This was found to be statistically significant (p < 0.05). The mean duration of the second stage of labor was longer in the study group (29.02 minutes) than in the control group (16.86 minutes) (p < 0.05). There was no significant adverse maternal and fetal outcome. Conclusion:The PNB provides an effective analgesia in the second stage of labor without the major neonatal and maternal morbidity.Clinical significance: The PNB can be provided by obstetricians in any delivery setup, even in low resource settings, without the need for skilled anesthetists.

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“…Sam J, et al [13] tried low dose ketamine infusion in a loading dose of 0.2 mg/kg delivered over 30 min followed-by an infusion at 0.2 mg/kg/h and concluded that it could provide acceptable labor analgesia.…”

Section: Discussionmentioning

confidence: 99%