Effects of intraoperative intravenous administration of analgesic dose of Ketamine during spinal anesthesia for cesarean section

Krekar Abdulssttar  Hamad; Hiwa Fateh  Saber

doi:10.56056/amj.2025.365

Authors

Krekar Abdulssttar Hamad M.B.Ch.B., F.A.B.A.ICU (Anesthesiologist and Intensivist), Pirmam teaching hospital, Erbil City, Region of Kurdistan, Iraq
Hiwa Fateh Saber M.B.Ch.B., F.I.C.M.S.A.I.C (Anesthesiologist and Intensivist), Hawler teaching hospital, Erbil City, Region of Kurdistan, Iraq

DOI:

https://doi.org/10.56056/amj.2025.365

Keywords:

Analgesia, Cesarean section, Intravenous, Ketamine, Spinal Anesthesia

Abstract

Background and objectives: The most common anesthetic technique in the cesarean section is spinal anesthesia. Our objectives were to identify the patient’s status by the use of analgesic dose of ketamine given intravenously during the first hour of spinal anesthesia for cesarean section operation.

Methods: This case control study was performed on 100 full term pregnant ladies, undergoing elective cesarean section by spinal anesthesia, in Erbil Maternity Teaching Hospital between the period of May 2021 until October 2021. Randomly 50% of them selected to give ketamine in an analgesic dose (0.35 mg/kg IV). Arterial blood pressure, heart rate, intra operative nausea and vomiting, peripheral capillary oxygen saturation, hallucination, shivering and anxiety were checked at 5 minutes before the spinal injection, and every 5 minutes interval after the injection. The use of ephedrine, rescue antiemetics was written.

Results: Mean arterial pressure in selected group where ketamine was used was significantly higher p<0.001 (100.3±13.9mmHg) with a more stable heart rate compared to that in the control group (99.4±15.4mmHg). Statistically significant (p<0.001) less ephedrine (total dose) used in the ketamine group (6 patients versus 39 patients in control group) as well as rescue antiemetics (2 versus 9, p=0.025). Shivering (p>0.999), and anxiety (p=0.102) had no statistically significant difference between the two groups.

Conclusion: Analgesic dose of ketamine intravenously can be beneficial in inhibiting hypotension after spinal anesthesia (less need for vasoconstrictors) and less intraoperative nausea and vomiting in parturient undergoing cesarean section.

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References

Olawin AM, Das JM. Spinal anaesthesia, Treasure Island, FL: Stat Pearls Publishing; 2019.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology. 2004 Oct 1;101(4):950-959.

Maheshwari K, Naguib MA. Local anesthetics. In: Flood P, Rathmell FS, Shafer S, (eds). Stoelting’s Pharmacology and Physiology in Anesthetic Practice. 5th Edition, Wolters Kluwer Health: 2015(10):282-313.

Butterworth JF, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology. 1990;72(4):711-34.

Butterworth JIV.Clinical Pharmacology of Local Anesthetics. In: Hadzic A, (ed). Hadzic's textbook of regional anesthesia and acute pain management. 2nd Edition, McGraw-Hill Education 2017 (7):124-137.

Nowacka A, Borczyk M. Ketamine applications beyond anesthesia–A literature review. Eur J Pharmacol. 2019; 860:172547.

Hirota K, Lambert DG. Ketamine: its mechanism (s) of action and unusual clinical uses. Br J Anaesth. 1996 Oct 1;77(4):441-444.

Sleigh J, Harvey M, Voss L, Denny B. Ketamine–More mechanisms of action than just NMDA blockade. Trends Anaesth. Crit. 2014;4(2-3):76-81.

Himmelseher S, Durieux ME, Weiskopf RB. Ketamine for perioperative pain management. Anesthesiology. 2005;102(1):211-20.

Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg. 2004;99(2):482-95.

Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS Neurosci Ther. 2013;(6):370-380.

Grace RF. The effect of variable?dose diazepam on dreaming and emergence phenomena in 400 cases of ketamine?fentanyl anaesthesia. Anaesthesia. 2003;58(9):904-910.

Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005;14(3):230-41.

Ashagrie HE, Filatie TD, Melesse DY, Mustefa S. The incidence and factors associated with intraoperative nausea and vomiting during cesarean section under spinal anesthesia, July 2019. An institution based cross sectional study. Int. J. Surg. Open. 2020; 26:49-54.

Balki M, Kasodekar S, Dhumne S, Carvalho JC. The prophylactic granisetron does not prevent postdelivery nausea and vomiting during elective cesarean delivery under spinal anesthesia. Anesth Analg. 2007;104(3):679-83.

Ure D, James KS, McNeill M, Booth JV. Glycopyrrolate reduces nausea during spinal anaesthesia for caesarean section without affecting neonatal outcome. Br J Anaesth. 1999;82(2):277-9.

Fujii Y, Numazaki M. Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery. Obstet Gynecol. 2002;99(1):75-9.

Hassanein A, Mahmoud E. Effect of low dose ketamine versus dexamethasone on intraoperative nausea and vomiting during cesarean section under spinal anesthesia. Egyptian J Anaesth. 2015;31(1):59-63.

Shabana AM, Nasr ES, Moawad HE. Effect of ketamine on intraoperative nausea and vomiting during elective caesarean section under spinal anaesthesia: A placebo-controlled prospective randomized double blinded study. Egyptian J Anaesth. 2012;28(2):169-74.

Seyam SH. Prevention of post-spinal anesthesia shivering: Low dose ketamine vs tramadol. Al-Azhar Int Med J. 2020;1(4):108-15.

Shukla U, Malhotra K, Prabhakar T. A comparative study of the effect of clonidine and tramadol on post-spinal anaesthesia shivering. Indian J Anaesth. 2011;55(3):242.

Kose EA, Dal D, Akinci SB, Saricaoglu F, Aypar U. The efficacy of ketamine for the treatment of postoperative shivering. Anesth Analg. 2008 ;106(1):120-122.

Lee A, Kee WD, Gin T. Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review. Can J Anesth. 2002;49(6):588-99.

Salah D, Alansary AM. Impact of Sub-Anesthetic Dose of Ketamine on Post Spinal Hypotension in Cesarean Delivery. Open Anesth J. 2019;13(1).

Dyer RA, Farina Z, Joubert IA, Toit P Du, Meyer M, Torr G, et al. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care 2004;32(3): 351-357.