Korean J Pain.  2013 Jul;26(3):270-276. 10.3344/kjp.2013.26.3.270.

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

• Han SY
• Jin HC
• Yang WD
• Lee JH
• Cho SH
• Chae WS
• Lee JS
• Kim YI

• KMID: 2074028
• DOI: http://doi.org/10.3344/kjp.2013.26.3.270

Abstract

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-microg 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.

Keyword

caesarean delivery; ketamine; patient-controlled analgesia; preemptive analgesia; spinal anesthesia

MeSH Terms

Analgesia
Analgesia, Patient-Controlled
Anesthesia, Spinal
Cesarean Section
Female
Fentanyl
Humans
Ketamine
N-Methylaspartate
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Pregnancy
Fentanyl
Ketamine
N-Methylaspartate

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