The effect of low-dose intravenous ketamine on shoulder pain following caesarean section under spinal anesthesia

Evaluation of effect of low dose IV Ketamine on shoulder pain followed by CS under spinal anesthesia Background: one of the common complications of CS is shoulder pain. Prevalence of shoulder pain is more common in CS than more common in NVD, and in cases in which spinal anesthesia is used is more commonly seen. Surgical site pain is also one of the on going complication in CS. If an anti-pain drug is used before the stimulation, it can reduce severity of pain and usage of painkillers. Ketamine is one of the successful painkiller in reducing pain. This study was performed in order to evaluate effect of low dose ketamine on shoulder pain followed by CS. Methods: In this randomized double-blind study group of 40 pregnant woman was chosen for intervention and a group of 40 was chosen as the control group. All the woman met the inclusion criteria. Control group recieved 5CC of the pure water as placebo and the second group received 0/2 mg/kg IV ketamine. All vital sings before and after the surgery were registered. Neonates APGAR was registered, and other data was complicated based on the question form and after the surgery. Results: prevalence of vomiting was 45% in placebo group and 30% in ketamine group. prevelance of nausea was 62% in placebo and 505 in ketamine group. Intervention did not effect on the vital sings and there were same on the both group. ketamine had no effect on neonate APGAR. Shoulder pain was 5% in placebo group( all on the right side) and 15% in ketamine group( 83% in the right side and 16% in the left side). The side of the shoulder pain was the opposite side of the catheter site. Surgical side pain was 5% in placebo and 10% in ketamine. pain was mild in all cases. The average time of onset of pain( shoulder – surgical site) was 1/5 hour in placebo and 3/5-4 hours in ketamine group. 63% of ketamine group had some level of hallucination. Conclusion: based on this study prophylactic use of ketamine has no effect on reducing the pain followed by CS but it delays the onset of pain. But there’s the possibility of minor complications for the mother but there’s no bad effect on the neonate. Key words: spinal anesthesia- ketamine- shoulder pain- cesarea