Key result
Preemptive ketamine prolongs time to first analgesic request and reduces pethidine dose vs MgSO4 and placebo.
Why the study?
Does preemptive low dose ketamine or MgSO4 improve postoperative analgesia in parturient females undergoing cesarean section under general anesthesia?
RCT (n=60)
Blind
Does preemptive low dose ketamine or MgSO4 improve postoperative analgesia in parturient females undergoing cesarean section under general anesthesia?
Preemptive low-dose ketamine provides superior early postoperative analgesia compared to magnesium sulfate in patients undergoing cesarean section under general anesthesia.
Supports preemptive low-dose ketamine for superior post-cesarean analgesia under GA; confirms benefit over MgSO4 in this RCT.
ObjectiveTo investigate the efficacy of the preemptive analgesic effect of low dose ketamine versus MgSO4 on potentiating postoperative analgesia when compared to placebo in patients undergoing cesarean section under general anesthesia.MethodsThis prospective randomized blind study included 60 parturient females scheduled for cesarean section under general anesthesia. They were randomized into three equal groups [20 patients each]: group I [Control]: received 20 ml normal saline 0.9%, group II [Ketamine]: received ketamine 0.3 mg/kg in 20 ml normal saline and group III [MgSO4]: received MgSO4, 30 mg/kg in 20 ml normal saline. Investigated medications infused over 10 min before induction of anesthesia. Fentanyl requirement, mean BP and HR were measured intraoperatively. Pain, sedation and nausea and vomiting were assessed at 2, 6, 12 and 24 h postoperatively. Total postoperative pethidine dose over 24 h was calculated.ResultsMBP and HR showed statistically significantly lower value in group (K) and (M) compared to group (C) at postintubation and postincision readings. Intraoperative fentanyl requirement was statistically higher in (C) groups compared to (K) and (M) groups. The time for first request for postoperative analgesia was longer and the total postoperative pethidine dose over 24 h was lower in (K) group compared to (C) and (M) groups. Postoperative VAS scores at 2 and 6 h postoperatively showed statistically highly significantly lower values in (K) group compared to (C) and (M) groups. Apgar, postoperative sedation and PONV scores showed no statistically significant differences among the three groups.ConclusionsPreemptive dose of either ketamine (0.3 mg/kg) or MgSO4 (30 mg/kg) in patients undergoing cesarean section under general anesthesia could suppress the pressor response to endotracheal intubation and skin incision and decreased the intraoperative fentanyl requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 6 h postoperatively.
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Helmy et al. (2015) conducted an RCT in Cesarean section under general anesthesia (n=60). Ketamine and Magnesium Sulfate vs. Placebo (normal saline 0.9%) was evaluated on Postoperative analgesia (time for first request, total pethidine dose, VAS scores). Preemptive ketamine (0.3 mg/kg) significantly prolonged time to first analgesic request and reduced 24-hour pethidine dose compared to MgSO4 (30 mg/kg) and placebo in cesarean section.
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