Postoperative analgesic requirement after cesarean section: a comparison of anesthetic induction with ketamine or thiopental.
In a randomized, double-blind study, we compared postoperative pain and analgesic requirement in patients who underwent elective cesarean section under general anesthesia induced with thiopental 4 mg/kg (n = 20) or ketamine 1 mg/kg (n = 20). Anesthesia was maintained with nitrous oxide and isoflurane. Postoperative analgesia was provided by patient-controlled analgesia (PCA) using morphine. Median (range) time to first PCA demand was greater in the ketamine group (28 [3-134] min) compared with the thiopental group (20.5 [3-60] min; P = 0.04). Median (range) morphine consumption over 24 h was less in the ketamine group (24.3 [3-41] mg) compared with the thiopental group (35 [4-67] mg; P = 0.017). Visual analog scale pain scores were similar between groups. No patients had recall of intraoperative events or unpleasant dreams. Two patients in the thiopental group and one patient in the ketamine group had pleasant intraoperative dreams. Apgar scores were similar between groups. Median umbilical venous pH was higher (7.33 vs 7.31; P = 0.04) and attributable to lower median umbilical venous Pco2 (5.72 vs 6.14 kPa; P = 0.02) in the ketamine group compared with the thiopental group. Induction of anesthesia for cesarean section using ketamine is associated with a lower postoperative analgesic requirement compared with thiopental.


CONCLUSIONS
Patients who had anesthesia for cesarean section induced with ketamine required less analgesic drugs in the first 24 h compared with patients who received thiopental. Ketamine, unlike thiopental, has analgesic properties that may reduce sensitization of pain pathways and extend into the postoperative period.
Ngan Kee
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Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. warwick@cuhk.edu.hk
Khaw
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Mainland
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Gin
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D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007649:Ketamine; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D013874:Thiopental
D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D009020:Morphine; D013874:Thiopental