Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

Abstract

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine's postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.” Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178.

Effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia: A prospective cohort study, Ethiopia

“…In Contrast to our study finding, study conducted in Uganda, 2017 showed diclofenac consumption was significantly lower in ketamine 75 (75–150) than control group 150 (75–150) in mg, but, total tramadol consumption was not significant [ 33 ]. This difference may due to pain control protocol difference, study design and sample size.…”

“…This may increase satisfaction level of parturients, decrease post operative analgesia consumptions as request time elapsed and avoid side effect of multiple drug consumption in immediate post operative period. In line with our result, study done in Uganda, 2017 showed that median (range) time (in minutes) to first analgesia request was Significantly longer in the ketamine group [210 (90–270)] than control group [180 (90–360)] [ 33 ]. Similarly, RCT done in Nigeria, 2012 match with our study result that showed first analgesia request time was significantly higher in ketamine group(209 ± 14.7min) than control group (164 ± 14.1) [ 20 ].…”

Effect of ketamine combined with lidocaine in pediatric anesthesia

“…5 Based on its effective bronchodilating respiratory properties and stable hemodynamics, ketamine use has been reported in patients with brain injury, resulting in increased clinical use. 6 Moreover, the administration of ketamine as an anesthetic has branched for extraperitoneal procedures, cardiac catheterization, orthopedics, and skin grafting, as well as otolaryngology and optical procedures. 7 Lidocaine, firstly synthesized by the Swedish chemist Lofgren, has been used extensively, such as for pain management, clinical anesthesia, nervous system diseases, arrhythmia, treatment of respiratory diseases, and gastrointestinal diseases.…”

“…Ketamine is acknowledged among the oldest hypnotic agents for anesthesia due to its analgesic properties and minimal suppressive effects on respiration . Based on its effective bronchodilating respiratory properties and stable hemodynamics, ketamine use has been reported in patients with brain injury, resulting in increased clinical use . Moreover, the administration of ketamine as an anesthetic has branched for extraperitoneal procedures, cardiac catheterization, orthopedics, and skin grafting, as well as otolaryngology and optical procedures .…”

Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies

“…Ketamine is an antagonist of the N-Methyl-D-Aspartate (NMDA) receptor which is often used as an anesthetic agent. NMDA receptor antagonists can provide an analgesic effect by desensitizing NMDA receptors, therefore inhibiting pain transmission in the central nervous system (7). Greater attention should be paid to this drug because it has been proven to be effective in relieving pain and is relatively available in remote areas (8).…”