Double blind controlled clinical trial of comparison of levobupivacaine versus levobupivacaine with ketamine in elective caesarean section

Abstract

Aim: The aim of the present study to comparison of levobupivacaine alone versus levobupivacaine with ketamine in subcutaneous infiltration for postoperative analgesia in lower segment caesarean section. Material and Methods: A randomized double blind controlled study conducted in the Department of Anaesthesiology, Metro Hospital and Cancer Research Center, Jabalpur, Madhya Pradesh, India. A total of 100 adult parturient of Physical status II or III as per the American society of anesthesiologists (ASA) without any medical or obstetrical problems, and scheduled for cesarean section under spinal anesthesia were included in this study. Parturients were randomized to one of the two groups (50 each) according to computer generated random numbers kept in separate, sealed, and numbered envelopes. Group A parturients received subcutaneous surgical wound infiltration with a solution of 0.5% levobupivacaine at 2 mg/kg body weight (rounded to nearest multiple of 10) to a maximum of 150 mg (maximum safe dose) diluted with normal saline to a total of 32 ml. Group B parturients received subcutaneous surgical wound infiltration with a solution of 0.5% levobupivacaine 2 mg/kg body weight (rounded to nearest multiple of 10) to a maximum of 150 mg plus ketamine 1 mg/kg body weight diluted with normal saline to a total volume of 32 ml. Results: We observed that both the groups were comparable with respect to demographic data. The zero hour (baseline) mean heart rates were comparable between groups A and B (P = 0.957). The mean heart rate of group A was higher than that of group B which was statistically insignificant at majority of the time points except at 4th and 6th hour post-operative. The intra group comparison of mean heart rate showed a gradual decrease in values across time in both the groups but was more prominent in group B. Correspondingly, parturients in group A had higher mean VAS scores than those in group B at all-time intervals and statistically significant difference were observed at 1, 4, 6, and 12 hours. Conclusion: We concluded that the ketamine is an effective adjunct modality to levobupivacaine for local wound infiltration in terms of superior pain relief, lesser need for rescue opioid analgesia, and no major side effects.