A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery


Unlugenc H. , Ozalevli M., Gunes Y., Olguner S., Evruke C., Ozcengiz D. , ...More

EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol.23, no.12, pp.1018-1024, 2006 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 23 Issue: 12
  • Publication Date: 2006
  • Doi Number: 10.1017/s0265021506000950
  • Title of Journal : EUROPEAN JOURNAL OF ANAESTHESIOLOGY
  • Page Numbers: pp.1018-1024
  • Keywords: anaesthetics, intravenous, ketamine, local anaesthetics, bupivacaine, analgesics, opioid, fentanyl, spinal anaesthesia, REDUCES POSTOPERATIVE PAIN, SPINAL-ANESTHESIA, KNEE ARTHROPLASTY, MORPHINE, SURGERY, ANTINOCICEPTION, ROPIVACAINE, RECEPTOR, BLOCK, RATS

Abstract

Background, In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10mg) for spinal analgesia. Methods: Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg(-1) of S(+) ketamine (1.0 mL) in Group K (n = 30) or 25 mu g (1.0 mL) of fentanyl in Group F (n = 30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia. Results: The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001). Conclusion: In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg(-1)) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.