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

Sen, S.a1,c1; Ozmert, G.a2; Aydin, O. N.a3; Baran, N.a4; Calskan, E.a4ı

European Journal of Anaesthesiology (EJA): July 2005 - Volume 22 - Issue 7 - p 518–523
doi: 10.1017/S026502150500089X
Original Article

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.

a1 Adnan Menderes University, Department of Anaesthesiology and Reanimation, Aydın, Ankara, Turkey

a2 SSK Etlik Gynecology and Obstetric Clinic in Ankara, Anaesthesiology Department, Etlik, Ankara, Turkey

a3 Adnan Menderes University, Department of Anaesthesiology and Reanimation/Algology, Aydın, Ankara, Turkey

a4 SSK Etlik Gynecology and Obstetric Clinic in Ankara, Gynecology and Obstetric Department, Etlik, Ankara, Turkey

c1Correspondence to: Selda Sen, Adnan Menderes University Medical Faculty - Anaesthesiology, Cumhuriyet Mahallesi, 1976 Sokak, 2/10, Aydın 09100, Turkey. E-mail:; Fax: +90 2562120146

Accepted for publication May 2005

© 2005 European Society of Anaesthesiology