بررسی اثر انفیلتراسیون زیر جلدی کتامین بر کاهش درد پس از عمل در بیماران کاندید سزارین الکتیو تحت بی حسی نخاعی

Introduction & Objective: Appropriate analgesia after cesarean section helps women feel more comfortable and increase the mobility of the mother's and also their ability to take better care of their newborns. The purpose of this study was to investigate the effects of subcutaneous infiltration of ketamine on postoperative pain reduction and hemodynamic status of patients after elective cesarean section. Materials & Methods: This study was designed as a double blinded prospective, randomized clinical trial and 60 cases of women undergoing elective cesarean section under spinal anes-thesia were randomly assigned into two groups. For 30 cases in the ketamine group, infiltra-tion of subcutaneous ketamine 0.5 mg / kg was administered after closure of surgical inci-sion. 30 patients in the placebo group received subcutaneous infiltration of saline. During the patient's recovery time and after transferring to the ward, the VAS of pain and vital signs were continuously assessed. if VAS ≥ 3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. Prescribed number of suppositories and pethidine dosage were compared. The complications, such as hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded and compared. Statistical analysis was performed by SPSS16 software and ?2 and t-test. P< 0.05 was considered statistically significant in all of the cases. Results: In the course of systolic blood pressure, heart rate and arterial blood oxygen satura-tion during the first 24 hours, no significant differences were mentioned between the two groups. At the time of arrival to the recovery room and 30 minutes later, the mean VAS was not significantly different in the groups. However, the mean VAS at 1, 2 , 4 , 6 , 8 and 12 hours after surgery were significantly lower in the ketamine group (0.61±059 )than in the sa-line group (3.37±096) (P<0.001). The mean duration of analgesia in ketamine group was 9.87 ±2.98 hrs and in saline group was 2.17±0.79 hrs (P<0.001).The first analgesic request time in the ketamine group was significantly longer than the saline (P<0.001). No significant adverse effect was observed in the ketamine group. Conclusion: According to the increased length of postoperative analgesia with no adverse ef-fects and also decreased need for opioids, administration of subcutaneous ketamine is rec-ommended for post operative analgesia after elective Cesarean section under spinal anesthe-sia.