The Effect of Intravenous Ketamine on Analgesic Requirement after Spinal Anesthesia in Caesarean Section: a Randomized Clinical Trial

Background & aim: The use of opioids for pain relief after cesarean section (C/S) can result in adverse maternal and neonatal outcomes. Therefore, it is important to consider non-opioid analgesics as an alternative. This study examined the effect of intravenous ketamine on analgesic requirement after spinal anesthesia in C/S.Methods: This double-blind randomized clinical trial ۸۰ pregnant women under spinal anesthesia during a planned C/S were recruited from trainig hospitals of Mashhad, Iran between February and August ۲۰۲۲. The participants were selected using convenience sampling and assigned to two intervention (۴۰) and control (۴۰) groups through random allocation. The intervention group received intravenous ketamine (۰.۵ mg/kg) and midazolam (۰.۰۲ mg/kg) immediately after umbilical cord clamping, while the control group received midazolam alone (۰.۰۲ mg/kg). Pain scores were recorded at the ۰th, ۶th, ۱۲th, and ۲۴th hours after elective C/S using the Visual Analog Score (VAS), along with the amount of requiremen to analgesics. Data analysis was performed by SPSS software (version ۱۶) using Chi-square, T-test and repeated measure ANOVA test.Results: A significant difference in pain scores between the two groups at different hours and over time (P=۰.۰۰۹). The intervention group reported significantly lower levels of pain than the control group (P=۰.۰۰۲) and a significantly lower need for painkillers during the first hour (P=۰.۰۴).Conclusion: Administration of intravenous ketamine in elective C/S with spinal anesthesia in the first hour has a significant effect on reducing pain. Therefore, it can be considered the drug of choice for alleviating pain.

کلیدواژه ها:

Ketamine ، Midazolam ، Pain ، Cesarean section ، Spinal anesthesia