Comparative study of efficacy of intrathecal bupivacaine-ketamine with bupivacaine-fentanyl for caesarean section

Abstract

Background: Various adjuvants have been used with local anaesthetics in spinal anaesthesia for lower segment caesarean section (LSCS) to provide better haemodynamics & prolonged postoperative analgesia. The aim of this study was to compare onset & duration of sensory & motor block with haemodynamic stability of intrathecal ketamine and fentanyl added to Bupivacaine in spinal anaesthesia for two different group of patients posted for LSCS Method: Sixty patients of age between 18-35 years and ASA grade I and II were included and randomly divided in to two groups of 30 each. Group K received injection bupivacaine 10 mg with 10 mg Ketamine and Group F received injection Bupivacaine 10 mg with 12.5 mcg Fentanyl. The sensorimotor characteristics, haemodynamic parameters, neonatal outcome and side effects were noted and compared between two groups. Results: Group K showed higher sensory level (<0.05), rapid sensory (P<0.05) and motor (P<0.05) onsets, prolonged sensory (P<0.05) and motor (P<0.05) blocks as compared to group F.Hyperbaric bupivacaine- Ketamine had better haemodynamic stability and significantly reduced incidence of hypotension (P<0.05) and bradycardia (P<0.05). Apgar scores at 1 and 5 min were comparable in both groups (P = 0.2734 and 0.6731 respectively).Tachycardia was found in 16.66% cases in group K, whereas no patient developed tachycardia in group F. Conclusion: The combination of hyperbaric bupivacaine (0.5%) 10mg with ketamine (10mg) can be used as a safe and effective alternative to hyperbaric bupivacaine (0.5%) 10mg with fentanyl 12.5mcg for spinal anaesthesia in LSCS.