effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia: a randomized clinical trial

Low-dose ketamine has been considered a good substitute for opioids for controlling postoperative pain. The purpose of this study was to determine the effect of low-dose intravenous ketamine following cesarean section with spinal anesthesia on postoperative pain and its potential complications. One hundred and sixty pregnant women volunteered to participate in this randomized controlled trial. Participants were randomly divided into two groups [n=80 for each group]. Five minutes after delivery, the experimental group received 0.25 mg/kg ketamine while the control group received the same amount of normal saline. There was a significant difference between the two groups in the severity of pain at one, two, six, and 12 hours following surgery. Postoperative pain was significantly less severe in the experimental group. Compared to the control group, the experimental group felt pain less frequently and therefore asked for analgesics less often. On average, the number of doses of analgesics used for the participants in the experimental group was significantly less than the number of doses used for the control group. Analgesic side effects [including nausea, itching, and headache] were not significantly different between the two groups. However, vomiting was significantly more prevalent in the control group and hallucination was more common in the experimental group. We conclude that administration of low doses of ketamine after spinal anesthesia reduces the need for analgesics and has fewer side effects than using opioids. Further studies are required to determine the proper dose of ketamine which offers maximum analgesic effect. Furthermore, administration of low-dose ketamine in combination with other medications in order to minimize its side effects warrants further investigation

Gabapentin and Fluoxetine for treatment of psychological symptoms: a cross over study

The somatic and metabolic changes due to menopause can result in numerous symptoms including psychological symptoms. This study compares the effectiveness of Gabapentin vs. Fluoxetine in treatment of psychological symptoms of menopause. Methods:Eighty menopausal women with history of hot flashes and predefined psychological symptoms participated in a cross-over study conducted at the Amir-Al-Momenin hospital, Semnan, Iran. Participants were randomly divided into two groups: A and B. The study included two rounds of treatment, each 4 weeks long, separated by a two-week washout period. In the first round of treatment, group A was treated with Fluoxetine 20mg/d and group B with Gabapentin 300 mg/d. In the second round of treatment, group A received Gabapentin while group B received Fluoxetine [cross-over].All participants were asked to fill out the "Green Climacteric Scale" questionnaire at the beginning of the study and also following each round of treatment. They were also asked to monitor and keep track of the side effects of the medications by filling out another form. There was no significant difference between the two groups in age, body mass index, and age at menopause [p>0.05]. The severity of irritability, fatigue, difficulty in concentrating, difficulty in sleeping, nervousness, and palpitation reduced to a significantly greater extent when the participants were treated with Gabapentin than when they were treated with Fluoxetine. Side effects [tremor] developed in only 2 Fluoxetine users and 2 Gabapentin users during the first 4 weeks of treatment. Our findings suggest that Gabapentin is more effective in alleviating the psychological symptoms of menopause than Fluoxetine. Thus, we recommend Gabapentin 300 mg/d for menopausal women who primarily complain about psychological symptoms, or those with contraindication to hormonal therapy