Subcutaneous wound infiltration of ketamine is superior to bupivacaine in terms of pain perception and opioid consumption after cesarean section: a double-blinded randomized placebo-controlled clinical trial

OBJECTIVE

The aim of the present study was to evaluate the analgesic efficiency of SC ketamine, either alone or in combination with bupivacaine, following CS by means of postoperative pain and opioid need.

PATIENTS AND METHODS

One hundred and twenty women were allocated into 4 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group K (Ketamine, n=30) received SC 1 mg/kg ketamine. Group B (Bupivacaine, n=30) received SC 20 mL bupivacaine 0.5%. Group KB (Ketamine+Bupivacaine, n=30) received SC ketamine 1 mg/kg plus SC 20 mL bupivacaine 0.5%. Group P (Placebo, n=30) received SC 30 mL 0.9% saline (placebo).

RESULTS

VAS scores at resting and on coughing and analgesic consumptions were compared. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured. VAS scores at rest in Group P were higher than in Group KB at the 6th hour, while lower in Group K and Group KB than in Groups B or P at the 12th hour. Patients receiving placebo had higher coughing VAS scores than those receiving ketamine or ketamine+bupivacaine at 2nd, 6th and 12th hours. Patients in Groups P and B required higher doses of morphine than those in groups K or KB.

CONCLUSIONS

Subcutaneous ketamine, either alone or in combination with bupivacaine, provides a better postoperative pain relief and reduces postoperative opioid consumption when compared to use of bupivacaine alone.

The comparison of intraincisional bupivacaine infiltration and intravenous paracetamol administration for pain alleviation after cesarean section: a double-blinded randomized placebo controlled clinical trial

OBJECTIVE

This study aimed to compare the analgesic effect of subcutaneous (SC) bupivacaine and intravenous (IV) paracetamol on postoperative pain and opioid requisites in patients undergoing cesarean delivery.

PATIENTS AND METHODS

One hundred and five women were allocated into 3 groups in this prospective, double-blind, placebo-controlled, randomized trial. Group 1 received SC bupivacaine, Group 2 received IV paracetamol following surgery and every 6 hours for 24 hours in the postoperative period, Group 3 received SC 0.9% saline and IV 0.9% saline at similar periods. Visual analogue scale (VAS) pain scores at rest and coughing, at 15 and 60 minutes, and 2, 6 and 12 hours, and total opioid necessity were measured.

RESULTS

VAS scores at rest were higher in placebo group than in bupivacaine and paracetamol groups at 15 minutes (p=0.047) and 2 hours (p=0.004). VAS scores at coughing were higher in placebo group than in bupivacaine and paracetamol groups at 2 hour (p=0.001) and 6 hours (p=0.018). Placebo group needed higher (p<0.001) doses of morphine than paracetamol or bupivacaine groups.

CONCLUSIONS

Intravenous paracetamol decreases pain scores similar to SC bupivacaine in the postoperative period compared to placebo. Patients taking bupivacaine or paracetamol need fewer opioids than placebo.

Assessment of hearing via otoacoustic emission in patients that underwent spinal anesthesia

OBJECTIVE

In this study, our aim is to show the differences between the preoperative and postoperative otoacoustic emissions (OAE) value in patients, who underwent spinal anesthesia.

PATIENTS AND METHODS

The presented study was carried out as a randomized, double-blinded, prospective study upon the approval of Ethics Committee of Medicine School, Erciyes University. The study was conducted in accordance with the Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65 years), who underwent varicectomy operation in the Cardiovascular Surgery Department. For each of the patients, 3 OAE measurements were performed; the day before surgery, during surgery and the 1st day after surgery.

RESULTS

Significant differences were detected between the 2000 F2 measurements performed before, during and after the surgery (p<0.05). The differences originated from measurements performed before and during surgery. Significant differences were detected among 3000 F1 measurements performed before, during and after surgery (p<0.05). Hearing loss is one of the late complications of spinal anesthesia. In this study, we observed the differences between the preoperative and postoperative OAE values. The incidence of hearing loss detectable with auditory measurements has been reported to vary between 10 and 50%. Of these, 25% is clinically relevant or recognizable. However, it is considered to be a subjective test, because it is influenced from mental, motor and psychological status of the patient. But the management in hearing loss following spinal anesthesia is still controversial. Hearing loss is generally spontaneously resolved within a few days. However, there are case reports of hearing loss lasting for months.

CONCLUSIONS

In this study, we observed differences between some preoperative and postoperative OAE values.