Journal of Pain Research (Sep 2016)

Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia

  • Senapathi TGA,
  • Widnyana IMG,
  • Wiryana M,
  • Aribawa IGNM,
  • Aryabiantara IW,
  • Hartawan IGAGU,
  • Sinardja IK,
  • Suarjaya IPP,
  • Nada IKW,
  • Jaya AAGPS

Journal volume & issue
Vol. Volume 9
pp. 689 – 692

Abstract

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Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, Made Wiryana, I Gusti Ngurah Mahaalit Aribawa, I Wayan Aryabiantara, I Gusti Agung Gede Utara Hartawan, I Ketut Sinardja, I Putu Pramana Suarjaya, I Ketut Wibawa Nada, AA Gde Putra Semara Jaya Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia Purpose: Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.Patients and methods: Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively.Results: Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively.Conclusion: Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia. Keywords: ketamine, stress response, pain, spinal anesthesia, cesarean section

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