Wound Infiltration Using Bupivacaine Versus Bupivacaine with Ketamine for Postoperative Analgesia Improvement in Cesarean Section Operations.

Abstract

A common procedure recently used is local anesthetic infiltration of surgical wounds that provides postoperative analgesia for a wide range of surgical operations with a minimum risk of side effects. A total of 60 pregnant women scheduled for elective cesarean section, were divided into 2 equal groups,30 patients each; the control (C) group: received 40 mL of 0.25% bupivacaine in two divided doses; and the ketamine (K) group: received 40ml of 0.25% bupivacaine plus 2 mg/kg ketamine, aiming to evaluate the efficacy of combined bupivacaine with ketamine on postoperative pain control following caesarean delivery. Heart rate, mean arterial blood pressure and respiratory rate were recorded at anaesthesia induction, and then every 10 min until the end of surgery. Mean arterial blood pressure, heart rate, respiratory rate and visual analogue scale were evaluated immediately postoperatively at the recovery room, then at 2,4,6,8,10, 12 and 24 hours postoperatively. Recording the time of the first painkiller request. (the time from recovery until VAS greater than 3) Collection of total doses of morphine requirement in 1st 24 hrs. VAS monitoring at the recovery room immediately postoperatively and then at 2, 4, 6, 8, 10, 12, and 24 hours postoperatively, patient satisfaction, 0 = no satisfaction and 10= full satisfaction. Data was then imported into Statistical Package for the Social Sciences (SPSS version 23.0) software for analysis. The ketamine group had a significantly longer duration before they needed analgesia (P < 0.001) as compared to the control group. opioid consumption in the ketamine group was much less than in the control group. (P< 0.001). patient in the ketamine group is more satisfied as compared to those in the control group (P < 0.001). We concluded that adding ketamine to bupivacaine in wound infiltration has a better effect than bupivacaine alone in controlling the hemodynamic parameters, a longer time for requesting analgesia postoperatively, patients’ satisfaction, and a smaller number of opioids needed on the first postoperative day.