Abstract

Background: Spinal anaesthesia is preferred technique for conducting abdominal hysterectomy, but it is insufficient to provide post-operative analgesia adequately. The addition of local anaesthetic adjuvants increases subarachnoid block efficacy and prolongs postoperative analgesia. Due to its fast onset with a limited time of action with minimal cephalic spread, Fentanyl is preferred as an adjuvant in spinal anaesthesia. Adding Fentanyl to a low dose, Bupivacaine offers improved surgical anaesthesia and increased block reliability. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anaesthetic agents, in fact it causes some stimulation of the cardiovascular system.
Objectives: To compare the Duration of the postoperative analgesia (Time of 1st rescue Analgesic) between intrathecal administration of Ketamine and fentanyl with bupivacaine. To compare the duration and onset of sensory and motor block (modified bromage scale), the effect on hemodynamic parameter, Degree of sedation and side –effects (post-operative nausea and vomiting, pruritus, shivering, urinary retention and any other).
Methodology: Two group were included in this study i.e. Group A & Group B. Both group had 18 cases for total abdominal hysterectomy Group A(n=10)- received 15mg of Bupivacaine 0.5% along with Fentanyl 25 mcg intrathecally and Group B (n=10)-received 15mg of Bupivacaine 0.5% along with Ketamine 25 mgintrathecally. The onset of sensory and motor block, duration of block, hemodynamic parameter, sedation score, total postoperative analgesia time, and side effects if any will be recorded.
Results: Demographic variables were compared between both groups A and B. Group A is A significant faster onset of sensory block was found in ketamine group in comparison to fentanyl group. (p-value<0.001). While the time to achieve the highest level of sensory block was found to be almost similar in both the groups.
Conclusion: ketamine or fentanyl to spinal bupivacaine were equally effective in pain control after abdominal hysterectomy