Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section

Bhiwal, Anil Kumar; Sharma, Vartika; Sharma, Karuna; Tripathi, Anuj; Gupta, Sunanda

doi:10.4103/joacc.joacc_21_19

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…In our study, the mean time to the first rescue analgesia was 6.5 h in Group K and 2.9 h in Group N, which was similar to a study done by Anil Kumar Bhiwal, 14 in which ketamine received by the Ka group was 0.15 mg/kg and the Kb group was 0.3 mg/kg given intravenously 5 min after delivery; Group C received 2 mL of 0.9 percent NS, and the time to the first analgesic requirement was significantly prolonged in the Ka group (5.44 ± 1.45 h) and the Kb group (6.18 ± 1.61 h) as compared to the control group (4.97 ± 1.48 h).…”

Section: Discussionsupporting

confidence: 90%

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Bagle

Pujari

Shah

et al. 2022

Journal of Pharmacology and Pharmacotherapeutics

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Background One of the most unpleasant aspects of surgery for a patient is postoperative discomfort. To treat the pain prophylactically, deliberate action should be taken. Exogenous opioids, such as morphine or fentanyl, have been used as the cornerstone of treatment to date. Opioid use is frequently linked to negative consequences. Ketamine is by far the most adaptable anesthetic medication accessible, possibly in all of medicine. Ketamine’s principal analgesic impact is because of its antagonism to N-methyl-D-aspartate receptors (NMDA) receptors. Ketamine affects pain processing in the central nervous system in this way. Ketamine has proven to be an effective antihyperalgesic, preventing opioid-induced hyperalgesia. Therefore, we investigated the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods This was a prospective, randomized, double-blinded study done over a period of two years. A total of 60 patients undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously in Group K and Inj. Normal Saline 10 mL was given intravenously in Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N ( P-value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP) were statistically and clinically not significant in both the intraoperative and postoperative periods in both the groups. Conclusion Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

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Section: Discussionsupporting

confidence: 90%

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Bagle

Pujari

Shah

et al. 2022

Journal of Pharmacology and Pharmacotherapeutics

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Comparison of Intravenous Ketamine Dosages for Postoperative Analgesia: Efficacy and Adverse Reactions in Abdominal Hysterectomy

Pauranik,

Girwal,

Sharma

et al. 2023

Acta Medica International

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Introduction: Following an abdominal hysterectomy, preemptive analgesia with two intravenous ketamine injections has been used as multimodal analgesia for postoperative pain. Ketamine’s ideal dosage for postoperative analgesia that has the least amount of adverse reactions is still up for discussion. Materials and Methods: This investigation was conducted at M.G.M. Medical College and M.Y. Hospital, Indore. The study included a total of 90 participants, classified as the American Society of Anesthesiologists classes 1 and 2, within the age range of 18–65 years. There were three groups made after dividing the patients with the help of the chit method so that no preference could be done. Group A was given an intravenous ketamine injection of 0.3 mg/kg, Group B was given an intravenous ketamine injection of 0.2 mg/kg, and Group C then got an intravenous ketamine injection of 0.1 mg/kg. In addition, all groups received subsequent 0.1 mg/kg ketamine injections every 30 min until the completion of the surgery. Various parameters were recorded for 24 h following the procedure, including the time to the first dosage, combined dose of rescue analgesia, combined number of doses of rescue analgesia, and incidence of adverse reactions. Results: The demographic profiles of all three groups were found to be comparable. The average time to request the first dosage of rescue analgesia was 316.33 ±66.345, 230± 44.721 & 89 ±26.698 minutes and 89 min, respectively, in Groups A, B, and C. Group A exhibited a significantly longer duration compared to Groups B and C. Postoperatively, at the 24-h mark, Group A displayed the lowest mean pain score (Visual Analog Scale) compared to Group B and Group C, with a statistically significant difference observed at P = 0.05. However, the frequency of nausea and vomiting between Groups A and B, as well as C, was not significant. Conclusion: Patients undergoing abdominal hysterectomy under spinal anesthesia experience reduced postoperative discomfort when administered intravenous ketamine at a dosage of 0.3 mg/kg, as opposed to lower doses. These results emphasize the potential benefits of higher dosage administration in enhancing postoperative analgesia in such procedures.

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Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section

Cited by 2 publications

References 14 publications

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Comparison of Intravenous Ketamine Dosages for Postoperative Analgesia: Efficacy and Adverse Reactions in Abdominal Hysterectomy

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