Introduction: Shivering is a common and challenging side effect of anaesthesia and may result in different degrees of perioperative hypothermia. Hence, the aim of the study was to compare the efficacy of ketamine to prevent shivering during subarachnoid block inpatient undergoing elective surgery. Material and Methods: We conducted a prospective randomized, double-blind placebo-controlled trial with total of 90 ASA I and II patients of either sex between the ages of 18-60 years undergoing elective infra-umbilical surgery under subarachnoid blocks. Random allocation of patients was done into Group1: ketamine at dose of 0.5 mg /kg (n=30), Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3: saline (n=30). Results: The study groups were comparable at the baseline. After spinal anaesthesia and concomitant administration of the study drug, shivering was observed only in 10% of patient with score 1 in Group 1 and Group 2. Whereas in placebo group 50% patients suffered different degrees of shivering and required treatment (p<0.05). After drug injection % of patient had higher sedation score (3 or 2) which was significantly higher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002). Only 3.3% patients of group1 experienced hallucination and rest of the patients in any group had no hallucination (P value= 0.045) Conclusion: Ketamine at a dose of 0.5 mg /kg had similar effects as that of ketamine at dose of 0.25 mg /kg when compared to placebo group. However, ketamine at dose of 0.5 mg /kg caused higher effects of sedation and hallucination.
Introduction: Midazolam produces an analgesic action through the benzodiazepine/γ-aminobutyric acid (GABA) A receptor complex in the spinal cord. We conducted this study to evaluate postoperative analgesic effects and associated complications of intrathecal midazolam in patients undergoing perineal surgery. Material and methods: 30 subjects belonging to ASA grade I and II scheduled to undergo elective perineal surgery under spinal anaesthesia were randomly allocated to either Group A-1 ml of 0.5% heavy bupivacaine+saline or Group B-1 ml of 0.5% heavy bupivacaine+preservative free midazolam. The duration of postoperative analgesia, postoperative visual analogue scores for pain, and perioperative side effects were noted. Results: The basic demographic characteristics were similar between the two groups. The mean duration of surgery was 22.33 ± 14.96 in group A, and it was 16.8 ± 12.55 in group B. The mean time to first pain medication was 4.93 ± 3.32 hours in group A, and it was 8.63 ± 6.17 in group B. The mean VAS at first pain medication was 40.00 ± 00 mm, and it was 40.00 ± 00 mm in group B. the mean difference in the postoperative analgesia between group was statistically significant (P value <0.02). Hemodynamic parameters did not differ between the groups. The complications included urinary retention among 5 (33.33%) in group A and 6 (40.00%) in group B. Conclusion: The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without any significant side effects.
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