Ketamine versus Tramadol for Analgesia in Spontaneous Vaginal Delivery: A Randomized Clinical Trial

Abstract

Background: The outcome of spontaneous vaginal birth is improved using analgesics during the three phases of labour. Both pharmaceutical and non-pharmaceutical approaches have been tried. Therefore, this study aimed to compare parenteral ketamine and tramadol regarding their analgesic effect and maternal and labor outcome.Patients and Methods: This randomized clinical trial was conducted on 100 primigravida and multigravida women. The study population was randomized into two equal groups; ketamine group: received low dose ketamine 0.4 mg/kg body weight intravenous [IV] slowly over 30-60 seconds with maintenance dose at the rate of 1 mg/min in normal saline after 30 min of induction dose using an infusion pump and the tramadol group: 1 mg/kg iv slowly for 5-10 minutes then after 30 min we start maintenance by IV Tramadol 0.3 mg /kg/hr.Results: Ketamine significantly decreased the time of onset analgesia [p=0.036] and VAS [p=0.002] than tramadol. Ketamine has a significant advance in patient satisfaction than tramadol. The duration of all 3 stages of labor, Apgar score after 1 min, Apgar score after 5 min, and the percentage of maternal complications did not exhibit any significant change between both groups.Conclusion: In spontaneous vaginal delivery, ketamine and tramadol are considered safe drugs with low complications and similar Apgar scores after 1 min and also after 5 min with superiority of ketamine than tramadol regarding the earlier time of onset analgesia, lower VAS score and better patient satisfaction.

Keywords

• ketamine
• tramadol
• analgesia
• spontaneous vaginal delivery