Shrikant Panachal¹,Nikhil Mudgalkar²

¹1Assistant Professor, Department of Anesthesia, ²Associate Professor, Department of Anesthesia, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India.

Address for correspondence Dr. Shrikant Panachal, Assistant Professor, Department of Anesthesia, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India.

Email: drskp.1981@yahoo.com

Introduction: Lignocaine and bupivacaine are the commonly used anesthetic agents for spinal anaesthesia. Ketamine when used intrathecally provides better surgical conditions with cardiovascular stability of short duration.

Materials and Methods : A prospective, randomized, double blinded study was conducted among 80 patients belonging to ASA grade I and II of either sex with age between 16 - 60 years posted for elective surgeries on the lower abdomen or lower extremities admitted in Prathima Institute of Medical Science during December 2012-13. The studied parameters included sensory, motor blockade, cardiovascular stability, side effect and postoperative complications. Statistical analysis was done using chi-square test, unpaired student's t test and paired student's t-test.

Results: A total of 80 patients were divided into two groups (40 each). The group I was given 3.5cc of 0.5% heavy bupivacaine whereas group II was given 2.5cc of 0.5% heavy bupivacaine and 1ml of preservative free ketamine (50mg). Onset of sensory block was quicker (1.95±0.26 min) in group II as compared to group I (2.56±0.55 min) and the difference was statistically significant (p<0.0001). Duration of sensory block (156.62±11.85 min) in group II was observed to be less as compared to group I (184.47±15.01 min) and it was statistically significant (p<0.0001). Mean Onset of motor block in group II (2.56±0.53min) was faster as compared to group I (3.18±0.74min) and was statistically significant (p<0.0001) whereas the mean duration of motor block in group II (181.75±12.17 min) was less as compared to bupivacaine (207.35±20.20 min) alone and this difference was statistically significant (p<0.0001). It was observed that addition of ketamine to bupivacaine showed haemodynamic stability than bupivacaine alone and this finding was found to be statistically significant (p<0.0001). The incidence of postoperative complication in the present study was almost nil except for mild headache in 2 patients (5%) in group I and 1 patient (2.5%) in group II.

Conclusion: The present study recommends the use of preservative free ketamine along with 0.5% bupivacaine intrathecally especially when early onset of block with cardiovascular stability is desirable.

Key words:: Ketamine, Bupivacaine, Spinal anaesthesia