Anaesthesia for Elective Caesarean Section: The Effect of Adding Ketamine to Epidural Ropivacaine/Fentanyl on Postoperative Pain Relief and Neonatal Outcome

Background: Ketamine has been reported to potentiate epidural local anaesthetics in non-obstetric surgery. This study was conducted to investigate the effect of adding ketamine to epidural ropivacaine/fentanyl for caesarean section (CS) on the analgesic profile and neonatal outcome. Methods: Thirty full-term females presenting for elective CS were randomized into two equal groups to receive epidural anaesthesia using ropivacaine 0.75% + 2µg/ml fentanyl in group C or ropivacaine 0.75% + 2µg/ml fentanyl + 0.5mg/kg preservative-free ketamine in group K. Visual analogue score (VAS) of pain, postoperative analgesic consumption (75mg i.m. diclofenac sodium), time to first request (TFR) of postoperative analgesic, heart rate (HR), mean arterial pressure (MAP) and patient sedation using the Observer s Assessment of Alertness/ Sedation (OAA/S) score were recorded during the first 24 postoperative hours. Time from skin incision to cord clamping (I-C time) and time from uterine incision to cord clamping (U-C time) were recorded as well as Apgar scores for the neonates at 1 and 5 minutes. Results: The two groups were comparable as regards HR (being slightly higher in group K) and postoperative MAR Intraoperatively, MAP was significantly lower in group C relative to baseline and to group K. VAS scores were significantly lower in group K than group C at 4, 12 and 16 hours postoperatively. TFR was significantly longer in group K, and the number of postoperative diclofenac doses was significantly lower. Patients were significantly more sedated in group K relative to group C at achievement of surgical anaesthesia and till the end of the operation, but not from 4 hours postoperatively till the end of the study. I-C time, U-C time and Apgar scores at 1 and 5 minutes were comparable between the groups. Conclusion: The addition of 0.5mg/kg preservative-free ketamine to epidural ropivacaine/fentanyl in women undergoing elective CS results in more haemodynamic stability and improves postoperative analgesia with no adverse effects on neonatal outcome.