Comparison between intrathecal Bupivacaine with Ketamine 15 mg versus Bupivacaine with Ketamine 20 mg in postoperative pain management after cesarean section.

Document Type : Original Article

Authors

1 Department of Anesthesia, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

2 Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.

Abstract

Background: Pain associated with cesarean section is the most discouraging side effect that might occur following surgery. When neuraxial anesthesia is being administered, Ketamine, which is a potent analgesic, may be given as an adjuvant. The ideal dosage of intrathecal Ketamine has not yet been completely determined. Aim: To evaluate the best dosage of Ketamine as an adjunct to intrathecal Bupivacaine by comparing the two doses of 15 mg and 20 mg intrathecal ketamine in patients delivering by cesarean section. Materials and Methods: Fifty women undergoing cesarean delivery using neuraxial anesthesia were arbitrarily distributed to receive   2 ml (10 mg) hyperbaric Bupivacaine 0.5% + 15 mg ketamine or 2 ml (10 mg) hyperbaric Bupivacaine 0.5% + 20 mg ketamine. The analgesic effect was evaluated by the Visual Analogue Scale at recovery, 2, 4, 8, 12, 18, and 24 hours after delivery. Request to first analgesic timing, dosage of morphine used, and complications were compared between groups. Results: Increasing the dose of intrathecal Ketamine to 20 mg was associated with prolonged sensory and motor blockage, longer after surgery analgesia, and lower morphine consumption while preserving the patient’s hemodynamics. Conclusion: Intrathecal 20 mg ketamine was superior to 15 mg ketamine as an adjunct to Bupivacaine concerning postoperative analgesia, as evidenced by the visual analog score and the total Morphine consumption, with lesser hemodynamic fluctuations.

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Suez Canal University Medical Journal
Volume 28, Issue 9
September 2025
Pages 77-85

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