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PREEMPTIVE ANALGESIC EFFECT OF LOW DOSE INTRAVENOUS KETAMINE ON SPINAL ANAESTHESIA IN LOWER LIMB SURGERY.
Abstract
Background: The N-methyl-D-aspartate (NMDA) receptor is an excitatory amino acid
receptor that has been implicated in modulation of prolonged pain states in animal
models. Ketamine, an NMDA antagonist has been shown to be useful in the reduction of
acute postoperative pain, analgesic consumption or both when added to the more
conventional means of providing analgesia such as opioids and regional blocks in the
perioperative period. This study was designed to look at the preemptive analgesic effect
of low dose intravenous ketamine on spinal anaesthesia in lower limb surgery.
Methods: Following approval from the Ethical Committee of National Orthopaedic
Hospital Dala-Kano and National Postgraduate Medical College, ninety-six (96) elective
orthopaedic patients for lower limb surgery were randomized into three groups. Spinal
anaesthesia was performed with 15 mg 0.5% hyperbaric bupivacaine in all the groups.
Ketamine (0.5 mg/kg) or an equal volume of normal saline was given intravenously
immediately after initiating spinal anaesthesia in the ketamine and control groups
respectively. In the fentanyl group, 25 µg fentanyl was added to the intrathecal
bupivacaine. Blood pressure, heart rate, respiratory rate, peripheral arterial oxygen
saturation value, adverse effects, the time of first request for postoperative analgesic,
pain intensity at that time using Visual Analogue Scale (VAS) and total analgesic
consumption in the first 24 hours were recorded in all the patients.
Results: Eighty-five patients completed (88.5%) the study. The time to first request for
analgesic was significantly longer in the ketamine (195 min) and fentanyl (156 min)
compared to control group (125 min). Postoperative pain scores were significantly lower
in the ketamine group than the other groups. The total analgesic consumed in the first 24
hrs was also lower in the ketamine group. There were no significant changes in the
haemodynamic parameters in all the groups and few adverse effects were observed.
Conclusion: Intravenous low dose ketamine 0.5 mg/kg body weight combined with
intrathecal bupivacaine for lower limb orthopaedic surgery provides longer postoperative
analgesia and lower analgesic consumption than bupivacaine alone, and a sustained
preemptive effect of ketamine was demonstrated.
PREEMPTIVE ANALGESIC EFFECT OF LOW DOSE INTRAVENOUS KETAMINE ON SPINAL ANAESTHESIA IN LOWER LIMB SURGERY.
