The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia

Abstract

BackgroundKetamine, 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.MethodsSpinal 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.ResultsSignificantly 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.ConclusionsIntraoperative 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.

Intrathecal Meperidine Plus Lidocaine for Prevention of Shivering during Cesarean Section

“…Likewise, spinal anesthesia is vastly used for cesarean section [2,3]. In spinal anesthesia for cesarean section, the anesthetized area (the sympathetic nerve innervated in the lower limbs) is blocked.…”

Post-caesarean analgesia: What is new?

“…A total of eight studies involving evaluation of analgesic efficacy of administration of intravenous ketamine in parturient undergoing CS were identified [Table 5]. [4546474849505152] Most of the trials (6 out of 8) used spinal anaesthesia for CS. The timing and the dose of ketamine administered were observed to be variable.…”

“…The timing and the dose of ketamine administered were observed to be variable. In two studies where general anaesthesia was used, ketamine was given before induction of anaesthesia[5052] whereas in three trials, involving spinal anaesthesia ketamine was administered immediately after subarachnoid block[444748] while in three it was given after delivery of the baby. [464951] Continuous infusion of ketamine was employed in two studies[4749] and in the remaining trials, bolus doses of ketamine varying from 1 to 0.15 mg/kg were used.…”

“…The reported outcomes were variable in these studies; two studies reported a negative outcome,[5051] two found ketamine to be effective in decreasing consumption of analgesics at 2 h post-operatively[4752] whereas five studies reported a positive outcome.…”

Intravenous ketamine infusion for a patient with treatment-resistant major depression: a 10-month follow-up

“…[1][2][3][4][5] Recently, ketamine in a subanaesthetic dose has been shown to have antidepressant effects. [1][2][3][4][5] Recently, ketamine in a subanaesthetic dose has been shown to have antidepressant effects.…”