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Hamzah
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Journal : Indonesian Journal of Anesthesiology and Reanimation (IJAR)

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Low-Dose Ketamine as Perioperative Analgesia in Caesarean Sections in Remote Areas with Limited Medical Supplies Avidar, Yoppie Prim; Salinding, Agustina; Hamzah; Uhud, Akhyar Nur; Maulydia
Indonesian Journal of Anesthesiology and Reanimation Vol. 4 No. 2 (2022): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V4I22022.87-97

Abstract

Introduction: Cesarean section is the most common surgical procedure performed in the world and its postoperative pain is still a major issue in several countries. In a low-resource setting, this management poses a challenge for anesthesiologists. Ketamine is the most used anesthetic drug in the world due to its easy access and proven benefits. Objective: This research aims to analyze the effectiveness of low-dose ketamine as postoperative analgesia in cesarean sections conducted in areas with limited medical supplies. Methods: A Randomized Controlled Trial (RCT) was done from August 2020 to January 2021 with consenting pregnant patients who had undergone cesarean section. The sampled population was randomized to receive either ketamine intravenously or a placebo before the Subarachnoid Block (SAB). Low dose ketamine was divided into three groups 0.15 mg/kg, 0.25 mg/kg, and 0.5 mg/kg. The outcome was divided into primary outcome (pain score after 1-hour post-operation, 2 hours post-operation, 24 hours post-operation, and 48 hours post-operation) and secondary outcome (Apgar Score in the first minute and 5 minutes, hypotension after SAB, sedative effect during operation, postoperative nausea vomiting, time to receive opioid postoperative as rescue analgesia and total opioid uses). Results: This study screened 105 patients and recruited 90 patients that were randomized into two groups consisting of 45 patients that received either low-dose ketamine or a placebo. The groups administered ketamine showed a lower pain score in 1 hour (p-value = 0.0037) and 2 hours post-operation (p-value = 0.0037). They also showed that it could prolong the administration of fentanyl (p-value = 0.0003) and lower total fentanyl used (p-value = 0.0008). The groups administered ketamine showed that there was a sedation effect (p-value = 0.0001) that depended on the dosage used. Conclusion: Intravenous ketamine with low doses can reduce pain scores at 1 hour to 2 hours post-operation and shows the need to reduce opioid requirements.
Co-Authors Abram Yoga Raharjo Abrar Tanjung Adi Sucipto, Adi Afandi, Alfa Astiana Afreni Hamidah Agustina Salinding Ahmad Ali Irfan Ahmed, Idris Adewale Akbar Azis, Muhammad Alimuddin Amir, Irfan Ana Sriekaningsih Andi Sugirman, Andi Andi Tabrani Rasyid Anhar Anna Surgean Veterini Anoesyirwan Moeins Ardianti, Andi Arham, Sarifuddin Arie Marbandi Arif Ardiansyah Arlenny Aswar Aulia Salsabila Avidar, Yoppie Prim Basilus Rinaldi Basir, Noerdin Budi Santoso Budiyarti, Yuliani Chitra Cita Rosita Sigit Prakoeswa Damayanti Tinduh David Setiawan, David Didik Notosudjono Djafar, Wihdat Djoyo, Rachmawati Dwi Budi Santoso Dwi Ratnasari Edison Eighty Mardiyan K, Eighty eka yati, Sri Fachruddin, Farianto Fahira Fathinah, Azzah Fatmawati Fatmawati Ficha Melina Firmansyah, M. Risal Fitrianti, Retno Ganding Sitepu Gunawan Gunawan Guspul, Ahmad Haris Djalante, Abdul Hartanto, Nono Hasmawati Helmi Amirudin Hendro Sasongko Herawati Herawaty Hutwan Syarifuddin Ian Vanath Alhakim Idrus Sahar Muhammad Ika Pratiwi Indra Putra, Edi Susrianto Indra Yanto Iskandar, Isna Islahudin Jalius Jamaluddin Jumarni Jumriadi Jumriani Nawawi Kara, Aisyah Kerlin Maysatria Khairil Anwar Khalid Rijaluddin Kiki Novia Arenty Kamisa Kurniati Lambang Basri Said Lenisya Winda Lilis Lina Warlina Linda Sekar Sari Linda Sekar Utami M Aizul Sofyan Syam M. Isnaini Maemonah, Maemonah Mahendra Amir, Ihza Maranatha, Daniel Mardiyantoro, Nahar Marina Zulfa Martin, Benedicto Reynaka Filio Mashud Maulydia Mayreista, Dita Melina, Ficha Misliah Idrus Mita Ariputri Moeins, Anoesyirwan Mohammad Diqi Mohtar, M. Sobirin Muhammad Anis Muhammad Arsyam Muhammad Aziz Dzikrur Rohman Muhammad Iswandi Wahyu Muhammad Jufri Muhammad Rusli Muhdar Mustafa, Wahyuddin MUTHMAINNAH Muyasaroh, Nurul Nancy Yusnita Napitupulu, Richard R.P. Natsir, Mohammad Neli Agusti Neneng Hasanah Nirmalawati Nur, Muafiah Nursakina Nurul Akma Oktaviona Oman Unju Subandi Ordiyasa, I Wayan Putra Wanda, Putra Rahmat Nur Hidayat Rian, Rica Rio Febrianto Riski Clausthaldi, Fadhil Roosganda Elizabeth Rosmani salihin Samararatne, Dinesha Sastrawati, Nila Servasius Hartoyo Sevinatul Nazati Shibghotillah, Nur Siddik, Hasbi Solikin Sri Jumini Sri Mardiyati Sri Wahyuni Ningsi Srinawati St. Chaerunnisa, Andi Suandar Baso Subijanto Marto Soedarmo Suci Cahya Ramadhani Sujoto, Ujo Surahman Amin, Surahman Suryanti Suwondo, Adi Suyud El Syam, Robingun Syafei, Ilham Syafi'i, Ahmad Syamsul Asri Syufriandi Syaiful Tahir Maloko Tri Setyo Guntoro Uhud, Akhyar Nur Ujo Sujoto Wawan Kusdiana Widia Astuti Widiyanto, Petrus Wijaya, Nurhadi Wijaya, Subur Yandri Yandri Yanuar Fitri, Yanuar Yulias Yusron Shidqi, Muhammad Zakirah, Zakirah Zulfa, Marina Zulfahri, Zulfahri Zulkarnain, Zulkarnain Zulkifli