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 effi- ciency of SC ketamine, either alone or in combi-nation 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 -con-trolled, randomized trial. Group K (Ketamine, n=30) received SC 1 mg/kg ketamine. Group B (Bupivacaine, n=30) received SC 20 mL bupiva-caine 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 cough-ing 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 mea-sured. VAS scores at rest in Group P were high-er 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 receiv-ing ketamine or ketamine+bupivacaine at 2nd, 6th and 12th hours. Patients in Groups P and B re-quired higher doses of morphine than those in groups K or KB. CONCLUSIONS: Subcutaneous ketamine, ei-ther alone or in combination with bupivacaine, provides a better postoperative pain relief and reduces postoperative opioid consumption when compared to use of bupivacaine alone.