The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia

  • Han, Seung Yeup (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jin, Hee Cheol (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Yang, Woo Dae (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Joon Ho (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Cho, Seong Hwan (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Chae, Won Seok (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Jeong Seok (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Yong Ik (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital)
  • Received : 2013.01.03
  • Accepted : 2013.03.07
  • Published : 2013.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. Methods: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-${\mu}g$ fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Results: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. Conclusions: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

Keywords

References

  1. Carvalho B, Cohen SE, Lipman SS, Fuller A, Mathusamy AD, Macario A. Patient preferences for anesthesia outcomes associated with cesarean delivery. Anesth Analg 2005; 101: 1182-7. https://doi.org/10.1213/01.ane.0000167774.36833.99
  2. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98: 153-8.
  3. Cassuto J, Wallin G, Högström S, Faxén A, Rimbäck G. Inhibition of postoperative pain by continuous low-dose intravenous infusion of lidocaine. Anesth Analg 1985; 64: 971-4.
  4. El-Tahan MR, Warda OM, Yasseen AM, Attallah MM, Matter MK. A randomized study of the effects of preoperative ketorolac on general anaesthesia for caesarean section. Int J Obstet Anesth 2007; 16: 214-20. https://doi.org/10.1016/j.ijoa.2007.01.012
  5. Weinbroum AA. Non-opioid IV adjuvants in the perioperative period: pharmacological and clinical aspects of ketamine and gabapentinoids. Pharmacol Res 2012; 65: 411-29. https://doi.org/10.1016/j.phrs.2012.01.002
  6. Yamamura T, Harada K, Okamura A, Kemmotsu O. Is the site of action of ketamine anesthesia the N-methyl-D-aspartate receptor? Anesthesiology 1990; 72: 704-10. https://doi.org/10.1097/00000542-199004000-00021
  7. Guirimand F, Dupont X, Brasseur L, Chauvin M, Bouhassira D. The effects of ketamine on the temporal summation (wind-up) of the R(III) nociceptive flexion reflex and pain in humans. Anesth Analg 2000; 90: 408-14.
  8. Aida S, Yamakura T, Baba H, Taga K, Fukuda S, Shimoji K. Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy: a randomized double-blind study. Anesthesiology 2000; 92: 1624-30. https://doi.org/10.1097/00000542-200006000-00020
  9. Ngan Kee WD, Khaw KS, Ma ML, Mainland PA, Gin T. Postoperative analgesic requirement after cesarean section: a comparison of anesthetic induction with ketamine or thiopental. Anesth Analg 1997; 85: 1294-8. https://doi.org/10.1213/00000539-199712000-00021
  10. Sen S, Ozmert G, Aydin ON, Baran N, Caliskan E. The persisting analgesic effect of low-dose intravenous ketamine after spinal anaesthesia for caesarean section. Eur J Anaesthesiol 2005; 22: 518-23. https://doi.org/10.1017/S026502150500089X
  11. Menkiti ID, Desalu I, Kushimo OT. Low-dose intravenous ketamine improves postoperative analgesia after caesarean delivery with spinal bupivacaine in African parturients. Int J Obstet Anesth 2012; 21: 217-21. https://doi.org/10.1016/j.ijoa.2012.04.004
  12. Reza FM, Zahra F, Esmaeel F, Hossein A. Preemptive analgesic effect of ketamine in patients undergoing elective cesarean section. Clin J Pain 2010; 26: 223-6. https://doi.org/10.1097/AJP.0b013e3181bff86d
  13. Bauchat JR, Higgins N, Wojciechowski KG, McCarthy RJ, Toledo P, Wong CA. Low-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial. Int J Obstet Anesth 2011; 20: 3-9. https://doi.org/10.1016/j.ijoa.2010.10.002
  14. De Kock M, Lavand'homme P, Waterloos H. 'Balanced analgesia' in the perioperative period: is there a place for ketamine? Pain 2001; 92: 373-80. https://doi.org/10.1016/S0304-3959(01)00278-0
  15. Howell PR, Gambling DR, Pavy T, McMorland G, Douglas MJ. Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine. Can J Anaesth 1995; 42: 41-5. https://doi.org/10.1007/BF03010570
  16. Clements JA, Nimmo WS. Pharmacokinetics and analgesic effect of ketamine in man. Br J Anaesth 1981; 53: 27-30. https://doi.org/10.1093/bja/53.1.27
  17. Schmid RL, Sandler AN, Katz J. Use and efficacy of lowdose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain 1999; 82: 111-25. https://doi.org/10.1016/S0304-3959(99)00044-5
  18. Behdad A, Hosseinpour M, Khorasani P. Preemptive use of ketamine on post operative pain of appendectomy. Korean J Pain 2011; 24: 137-40. https://doi.org/10.3344/kjp.2011.24.3.137
  19. Fu ES, Miguel R, Scharf JE. Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg 1997; 84: 1086-90. https://doi.org/10.1213/00000539-199705000-00024
  20. Bilgen S, Koner O, Ture H, Menda F, Ficicioglu C, Aykac B. Effect of three different doses of ketamine prior to general anaesthesia on postoperative pain following Caesarean delivery: a prospective randomized study. Minerva Anestesiol 2012; 78: 442-9.
  21. Roytblat L, Korotkoruchko A, Katz J, Glazer M, Greemberg L, Fisher A. Postoperative pain: the effect of low-dose ketamine in addition to general anesthesia. Anesth Analg 1993; 77: 1161-5.
  22. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth 2011; 58: 911-23. https://doi.org/10.1007/s12630-011-9560-0
  23. Suppa E, Valente A, Catarci S, Zanfini BA, Draisci G. A study of low-dose S-ketamine infusion as "preventive" pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva Anestesiol 2012; 78: 774-81.
  24. Dich-Nielsen J, Holasek J. Ketamine as induction agent for caesarean section. Acta Anaesthesiol Scand 1982; 26: 139-42. https://doi.org/10.1111/j.1399-6576.1982.tb01741.x
  25. Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates and young children. Anesth Analg 2007; 104: 509-20. https://doi.org/10.1213/01.ane.0000255729.96438.b0

Cited by

  1. Intrathecal Meperidine Plus Lidocaine for Prevention of Shivering during Cesarean Section vol.26, pp.4, 2013, https://doi.org/10.3344/kjp.2013.26.4.379
  2. Comments on "The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia" vol.27, pp.1, 2014, https://doi.org/10.3344/kjp.2014.27.1.90
  3. Intravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis vol.59, pp.4, 2015, https://doi.org/10.1111/aas.12468
  4. Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial vol.295, pp.5, 2017, https://doi.org/10.1007/s00404-017-4334-8
  5. Is intravenous ketamine effective for postoperative pain management in adults? vol.17, pp.Suppl2, 2017, https://doi.org/10.5867/medwave.2017.6952
  6. Intravenous ketamine infusion for a patient with treatment-resistant major depression: a 10-month follow-up vol.43, pp.4, 2018, https://doi.org/10.1111/jcpt.12669
  7. Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study vol.3, pp.None, 2014, https://doi.org/10.12688/f1000research.5258.1
  8. Comparison of pregabalin versus ketamine in postoperative pain management in breast cancer surgery vol.9, pp.3, 2013, https://doi.org/10.4103/1658-354x.154697
  9. Post-caesarean analgesia: What is new? vol.61, pp.3, 2017, https://doi.org/10.4103/ija.ija_313_16
  10. Management of post-cesarean delivery analgesia: Pharmacologic strategies vol.45, pp.4, 2013, https://doi.org/10.1097/01819236-201710000-00008
  11. Manejo analgésico durante el postoperatorio de cesárea: estrategias farmacológicas vol.45, pp.4, 2013, https://doi.org/10.1016/j.rca.2017.08.001
  12. Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section vol.9, pp.2, 2013, https://doi.org/10.4103/joacc.joacc_21_19
  13. A Comparative Study on the Use of Ketamine and Apotel Infusion Pump for the Control of Pain After Posterior Fusion Operations: A Randomized Controlled Trial vol.21, pp.8, 2013, https://doi.org/10.5812/semj.96751
  14. The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review vol.2021, pp.None, 2013, https://doi.org/10.1155/2021/2156918
  15. Placenta accreta spectrum disorders - Peri-operative management: The role of the anaesthetist vol.72, pp.None, 2013, https://doi.org/10.1016/j.bpobgyn.2020.08.003