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The persisting analgesic effect of low-dose intravenous ketamine after spinal anaesthesia for Caesarean section

Published online by Cambridge University Press:  29 June 2005

S. Sen ,
G. Ozmert ,
O. N. Aydin ,
N. Baran  and
E. Calıskan
S. Sen
Affiliation:
Adnan Menderes University, Department of Anaesthesiology and Reanimation, Aydın, Ankara, Turkey
G. Ozmert
Affiliation:
SSK Etlik Gynecology and Obstetric Clinic in Ankara, Anaesthesiology Department, Etlik, Ankara, Turkey
O. N. Aydin
Affiliation:
Adnan Menderes University, Department of Anaesthesiology and Reanimation/Algology, Aydın, Ankara, Turkey
N. Baran
Affiliation:
SSK Etlik Gynecology and Obstetric Clinic in Ankara, Gynecology and Obstetric Department, Etlik, Ankara, Turkey
E. Calıskan
Affiliation:
SSK Etlik Gynecology and Obstetric Clinic in Ankara, Gynecology and Obstetric Department, Etlik, Ankara, Turkey
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Extract

Summary

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 μg 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.

Keywords

ANAESTHESIA, CONDUCTIONANAESTHESIA, SPINALANAESTHETICS LOCAL, bupivacaineANAESTHETICS INTRAVENOUS, ketamineANALGESICS OPIOID, fentanylANAESTHESIA OBSTETRICALPAIN, POSTOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 7 , July 2005 , pp. 518 - 523
Copyright
© 2005 European Society of Anaesthesiology

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References

Elia N, Tramèr MR. Ketamine and postoperative pain – a quantitative systematic review of randomised trials. Pain 2005; 113: 61–70.Google Scholar
Kohrs R, Durieux ME. Ketamine: teaching an old drug new trick. Anesth Analg 1998; 87: 1186–1193.Google Scholar
Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain 1999; 82: 111–125.Google Scholar
Kissin I. Preemptive analgesia. Anesthesiology 2000; 93: 1138–1143.Google Scholar
Podder S, Wig J, Malhotra SK, Sharma S. Effect of pre-emptive analgesia on self-reported and biological measures of pain after tonsillectomy. Eur J Anaesthesiol 2000; 17: 319–324.Google Scholar
Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-d-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44: 293–299.Google Scholar
Guillou N, Tanguy M, Seguin P, Branger B, Campion JP, Malledant Y. The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Anesth Analg 2003; 97: 843–847.Google Scholar
Pockett S. Spinal cord synaptic plasticity and chronic pain. Anesth Analg 1995; 80: 173–179.Google Scholar
Gupta A, Axelsson K, Thorn SE et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7.5 mg of bupivacaine. Acta Anaesthesiol Scand 2003; 47: 13–19.Google Scholar
Ben-David B, DeMeo PJ, Lucyk C, Solosko D. Minidose lidocaine-fentanyl spinal anesthesia in ambulatory surgery: prophylactic nalbuphine versus nalbuphine plus droperidol. Anesth Analg 2002; 95: 1596–1600.Google Scholar
Meininger D, Byhahn C, Kessler P et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96: 852–858.Google Scholar
Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology 2005; 102: 211–220.Google Scholar
Fu ES, Miguel R, Scharf JE. Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg 1997; 84: 1086–1090.Google Scholar
Marcus RJ, Victoria BA, Rushman SC, Thompson JP. Comparison of ketamine and morphine for analgesia after tonsillectomy in children. Br J Anaesth 2000; 84: 739–742.Google Scholar
Tverskoy M, Oz Y, Isakson A, Finger J, Bradley Jr EL, Kissin I. Preemptive effect of fentanyl and ketamine on postoperative pain and wound hyperalgesia. Anesth Analg 1994; 78: 205–209.Google Scholar
Lee IO, Lee IH. Systemic, but not intrathecal, ketamine produces preemptive analgesia in the rat formalin model. Acta Anaesthesiol Sin 2001; 39: 123–127.Google Scholar
De Kock M, Lavand'homme P, Waterloos H. ‘Balanced analgesia’ in the perioperative period: is there a place for ketamine? Pain 2001; 92: 373–380.Google Scholar
Kawamata T, Omote K, Sonoda H, Kawamata M, Namiki A. Analgesic mechanisms of ketamine in the presence and absence of peripheral inflammation. Anesthesiology 2000; 93: 520–528.Google Scholar
Hirota K, Lambert DG. Ketamine: its mechanism(s) of action and unusual clinical uses. Br J Anaesth 1996; 77: 441–444.Google Scholar
Xie H, Wang X, Liu G, Wang G. Analgesic effects and pharmacokinetics of a low dose of ketamine preoperatively administered epidurally or intravenously. Clin J Pain 2003; 19: 317–322.Google Scholar
Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001; 48: 1000–1010.Google Scholar
Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both? Acta Anaesthesiol Scand 2003; 47: 1096–1100.Google Scholar
Roffey P, Mikhail M, Thangathurai D. NMDA receptor blockade prevents nitroglycerin-induced headaches. Headache 2001; 41: 733.Google Scholar
Kaube H, Herzog J, Kaufer T, Dichgans M, Diener HC. Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine. Neurology 2000; 55: 139–141.Google Scholar