Анестезия и клинические исследования
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ISSN: 2155-6148
ISSN: 2155-6148
Ahmed S El-Halwagy, Sameh M Fathy, Abdelghafar S Dawood
Background: Ketamine can give good analgesia even when given in a dose less than its anesthetic doses. No previous studies of using intranasal ketamine for labor analgesia have reported, hence the idea of this study.
Subjects and methods: In this study 105 patients attending the labor unit were included and they were randomized in 2 study groups. In group A (study group 1) the patients received an initial dose of 0.5 mg/kg intranasal ketamine, followed by a single repeat dose of 0.25 mg/kg intranasal ketamine after 1 h after the initial drug administration while in group B (study group 2) the patients received a standard 50 mg intramuscular pethidine injection, followed by a single repeat dose of 50 mg intramuscular pethidine injection 1 h after the initial drug administration. Average labor pain was assessed using Visual Analogue Scale (VAS) by direct questioning from patient in both groups and considered as the primary outcome measure.
Results: On comparing the final visual analogue score (VAS) between the two study groups it is significantly lower in the group A (Ketamine group) 49.5 ± 17.7 than in group B (Pethidine group) 52.2 ± 15.3 P value=0.008. The 5 min APGAR score is significantly higher in the group A (Ketamine group) 8.34 ± 1.31 than in group B (Pethidine group) 7.35 ± 1.74 P value=0.001. The rate of vomiting is significantly lower in the group A (Ketamine group) 3.77% than in group B (Pethidine group) 23.08% P value=0.001. The rate of hallucinations is significantly higher in the group A (Ketamine group) 33.96% than in group B (Pethidine group) 5.77% P value=0.000.
Conclusion: The use of intranasal ketamine in an initial dose of 0.5 mg/kg with supplementary dose of 0.25 mg/kg is more effective than the use of 50 mg intramuscular pethidine with supplementary dose of 50 m IM as labor analgesia with better fetal APGAR score at 5 min less vomiting incidence but with significantly higher rate of hallucinations.