title: Low-dose ketamine infusion for labor analgesia: A double-blind, randomized, placebo controlled clinical trial.
abstract: BACKGROUND
  Most primary and secondary level hospitals in developing countries provide inadequate labor analgesia due to various medical, technical and economic reasons. This clinical trial was an effort to study the efficacy, safety and feasibility of intravenous (IV) ketamine to provide labor analgesia.
  
  
  METHODS
  A total of 70 parturients were consented and randomly assigned to receive either IV ketamine or 0.9% saline. A loading dose of ketamine (0.2 mg/kg) was followed-by an infusion (0.2 mg/kg/h) until the delivery of the neonate. Similar volume of saline was infused in the placebo-group. Intramuscular meperidine was the rescue analgesic in both groups. The pain score, hemodynamic parameters of mother and fetus and the anticipated side-effects of ketamine were observed for. The newborn was assessed by the Neonatologist.
  
  
  RESULTS
  The pain score showed a decreasing trend in the ketamine group and after the 1(st) h more than 60% of women in the ketamine group had pain relief, which was statistically significant. There was no significant clinical change in the maternal hemodynamics and fetal heart rate. However, 17 (48.5%) of them had transient light headedness in the ketamine group. All the neonates were breast fed and the umbilical cord blood pH was between 7.1 and 7.2. The overall satisfaction was significantly high in the intervention group (P = 0.028).
  
  
  CONCLUSIONS
  A low-dose ketamine infusion (loading dose of 0.2 mg/kg delivered over 30 min, followed-by an infusion at 0.2 mg/kg/h) could provide acceptable analgesia during labor and delivery.
authors.affiliation: Department of Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
authors.forename: Sam
authors.initials: S
authors.lastname: Joel
authors.affiliation: Department of Anesthesia, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Joselyn
authors.affiliation: Department of Anesthesiology, Milton S Hershey Medical Center, PA, USA.
authors.forename: Verghese T
authors.initials: VT
authors.lastname: Cherian
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Amar
authors.initials: A
authors.lastname: Nandhakumar
authors.affiliation: Department of Anesthesia, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
authors.forename: Nithin
authors.initials: N
authors.lastname: Raju
authors.affiliation: Department of Anesthesia, The Queen Elizabeth Hospital, Adelaide, South Australia.
authors.forename: Ilamurugu
authors.initials: I
authors.lastname: Kaliaperumal
keywords: Ketamine infusion; labor analgesia; light headedness; low-dose ketamine; meperidine