Comparison between subcutaneous ketamine with intramuscular pethidine versus intramuscular pethidine for post-operative analgesia after cesarean section

Abstract

Abstract Background Cesarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system. Objective to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level. Patients and Methods The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia in Ain Shams University Hospitals and Helwan University Hospitals. Group A patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5. Group B patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5. Results There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study. There was highly significant increase in the time to first pethidine demand in group A than B. There was highly significant decrease in total dose of pethidine given (in group A than in B. Conclusion Subcutaneous ketamine with a dose of (0.9mg/kg) can be used in reducing pain in postoperative period after CS with minimal side effects. The addition of SC ketamine to the pethidine appear to cause more pain control and decrease the total dose of pethidine given in post-operative period.