ABSTRACT
Introduction: Shivering is a common and challenging sideeffect of anaesthesia and may result in different degrees ofperioperative hypothermia. Hence, the aim of the study was tocompare the efficacy of ketamine to prevent shivering duringsubarachnoid block inpatient undergoing elective surgery.Material and Methods: We conducted a prospectiverandomized, double-blind placebo-controlled trial with totalof 90 ASA I and II patients of either sex between the agesof 18 – 60 years undergoing elective infra- umbilical surgeryunder subarachnoid blocks. Random allocation of patientswas done into Group1: ketamine at dose of 0.5 mg /kg (n=30),Group2: ketamine at dose of 0.25 mg /kg (n=30), Group3:saline (n=30).Results: The study groups were comparable at the baseline.After spinal anaesthesia and concomitant administration ofthe study drug, shivering was observed only in 10% of patientwith score 1 in Group 1 and Group 2. Whereas in placebogroup 50% patients suffered different degrees of shivering andrequired treatment (p<0.05). After drug injection % of patienthad higher sedation score (3 or 2) which was significantlyhigher in Group 1 (3%) than Groups 2 and 3 (0%) (P=0.002).Only 3.3% patients of group1 experienced hallucination andrest of the patients in any group had no hallucination (P value=0.045)Conclusion: Ketamine at a dose of 0.5 mg /kg had similareffects as that of ketamine at dose of 0.25 mg /kg whencompared to placebo group. However, ketamine at dose of 0.5mg /kg caused higher effects of sedation and hallucination.
ABSTRACT
Introduction: Midazolam produces an analgesic actionthrough the benzodiazepine/γ-aminobutyric acid (GABA)Areceptor complex in the spinal cord. We conducted this studyto evaluate postoperative analgesic effects and associatedcomplications of intrathecal midazolam in patients undergoingperineal surgery.Material and methods: 30 subjects belonging to ASA gradeI and II scheduled to undergo elective perineal surgery underspinal anaesthesia were randomly allocated to either GroupA- 1 ml of 0.5% heavy bupivacaine+saline or Group B- - 1ml of 0.5% heavy bupivacaine+preservative free midazolam.The duration of postoperative analgesia, postoperative visualanalogue scores for pain, and perioperative side effects werenoted.Results: The basic demographic characteristics were similarbetween the two groups. The mean duration of surgery was22.33 ± 14.96 in group A, and it was 16.8 ± 12.55 in group B.The mean time to first pain medication was 4.93 ± 3.32 hoursin group A, and it was 8.63 ± 6.17 in group B. The mean VASat first pain medication was 40.00 ± 00 mm, and it was 40.00± 00 mm in group B. the mean difference in the postoperativeanalgesia between group was statistically significant (P value<0.02). Hemodynamic parameters did not differ between thegroups. The complications included urinary retention among 5(33.33%) in group A and 6 (40.00%) in group B.Conclusion: The addition of preservative-free midazolam tobupivacaine intrathecally resulted in prolonged postoperativeanalgesia without any significant side effects