title: Comparative study of hyperbaric bupivacaine plus ketamine vs bupivacaine plus fentanyl for spinal anaesthesia during caeserean section.
abstract: BACKGROUND
  Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia.
  
  
  OBJECTIVE
  The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine.
  
  
  METHODS
  One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups. Group A received 2ml (10 mg) hyperbaric bupivacaine 0.5% plus 25 mg preservative free ketamine. Group B received 2ml (10mg) hyperbaric bupivacaine 0.5% plus 25μg fentanyl. The patients were observed intraoperatively for the onset of sensory block, degree of motor block and total duration of analgesia.
  
  
  RESULTS
  The time to achieve Bromage scale 3 motor blockade was shorter in Group A than in Group B.(p= 0.445) whereas time to achieve highest dermatomal level of sensory block was shorter in Group A than in Group B (p= 0.143). The duration of spinal analgesia was longer in Group B than in Group A (p= 0.730). The frequency of side effect such as sedation score was higher in Group A compared to Group B (p= 0.048). The incidence of pruritus was significantly higher in Group B compared to Group A (p = 0.000).
  
  
  CONCLUSIONS
  Addition of preservative free ketamine lead to faster onset of sensory and motor blockade, although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia.
authors.affiliation: Department of Anesthesia, Dhulikhel Hospital - Kathmandu University Hospital Kathmandu University School of Medical Sciences Dhulikhel, kavre, Nepal.
authors.forename: S N
authors.initials: SN
authors.lastname: Shrestha
authors.affiliation: Department of Anesthesia, Dhulikhel Hospital - Kathmandu University Hospital Kathmandu University School of Medical Sciences Dhulikhel, kavre, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Bhattarai
authors.affiliation: Department of Anesthesia, Dhulikhel Hospital - Kathmandu University Hospital Kathmandu University School of Medical Sciences Dhulikhel, kavre, Nepal.
authors.forename: R
authors.initials: R
authors.lastname: Shah
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002585:Cesarean Section / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D007649:Ketamine; D005283:Fentanyl; D002045:Bupivacaine