الفهرس 
METHODS OF POST-OPERATIVE ANALGESIA AFTER CESARIAN SECTIONSOnly 14 pages are availabe for public view
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Abstract
SUMMARY
C
esarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system.
The aim of the study is to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level.
The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia.
group A: patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5.
group B: patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5.
Patients were assessed pre-operatively by detailed history taking, complete clinical examination, airway assessment and routine laboratory investigations. On arrival to the operating room, patients were connected to the standard monitoring; electrocardiograph, non-invasive arterial blood pressure and pulse oximetry. They were all subjected to the same anesthetic protocol.
Measurements
1. Demographic data:Age and weight
2. Duration of surgery in minutes: time from first incision to last skin suture
3. Vital signs: Heart rate (beats/min). Mean arterial blood pressure (mmHg). Were recorded at the following times: Base line (before spinal). At PACU and at 6, 12, 18, 24 and 30 hours after discharge from PACU.
4. Assessment of sedation: sedation level was evaluated by Ramsay Sedation Scale in the PACU and at 6, 12, 18, 24 and 30 hours after discharge from PACU.
5. Time to first analgesic requirement
6. Total amount of pethidine needed
7. Assessment of pain was evaluated by numerical rating scale (NRS, 0-10) at 6, 12, 18, 24 and 30 hours after discharge from PACU.
8. The presence of systemic (nausea-vomiting, drowsiness, dizziness, and hallucination) and/or local (hematoma, and swelling) side effects were observed.
The result of the present study showed that:
There was no statistically significant difference between both groups as regard the patient’s ages, their weights. There was statistically significant difference between both groups as regard duration of surgery.but that difference is about 6 mins between both groups.
There was significant increase in heart rate between two groups at PACU, 6, 12 and 24 hours post-operative with no significant change in the rest of the study.
There was significant increase in blood pressure between two groups at PACU, 6, 12, 24 and 30 hours postoperative with no significant change in the rest of the study.
There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study.
There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study.
There was no significant change in sedation scores between two groups) throughout the study.
There was highly significant increase in the time to first pethidine demand in group A than B.
There was highly significant decrease in total dose of pethidine given (in group A than in B.