| The Effects of Preoperative or Postperitoneal Closure Epidural Ketamine on Epidural Anesthesia and Analgesia for Obstetric Patients. |
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Jeong Yeon Hong, Yeun Woo Lee |
1Department of Anesthesiology, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
The NMDA receptor mediates wind-up and long-term potentiation in the responses of cells to prolonged stimuli; thus we postulated that the induction and maintenance of sensitization would be affected by the timing of epidural ketamine administration under epidural anesthesia.
METHODS
Sixty patients undergoing elective cesarian section were randomly and equally assigned to one of three groups.
20 ml of 2% lidocaine and 2 mg morphine with epinephrine was injected to all patients epidurally through an indwelling catheter inserted at the L2-3 interspace. Before surgical incision, the patients in group 1 were given 3 ml saline, while the patients in group 2 were given 30 mg ketamine. In group 3, patients were injected with 30 mg ketamine after peritoneal closure. An additional 2 mg morphine was injected into all patients 24 h after surgery. The analgesic effects were assessed and side effects were also evaluated.
RESULTS
VAS of group 3 at 3 24 h was lower than in the group 1, and at 6 24 h it was lower than in the group 2. The number of patients using additional analgesics in group 3 was lower than in the other groups. The incidence of nausea and vomiting was higher in the group 1 than in the other groups, but dizzness was higher in the groups 2 and 3 than in the control group.
CONCLUSIONS
Preoperative administration of epidural ketamine is less effective in reducing postoperative pain than when given after peritoneal closure, especially under epidural anesthesia with local anesthetics. |
| Key Words:
Analgesics, ketamine, morphine; Pain, postoperative |
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