Low dose ketamine for painless labour- A comparative study of 100 patients.

ABSTRACT

Background: The phencyclidine derivative Ketamine is widely used as intramuscular and intravenous anaesthetic agent. In contrast to other anaesthetics, ketamine has potent analgesic properties in sub-anaesthetic doses. Recent studies indicate that analgesia produced by ketamine is mediated through opiate receptors and N-methyl D aspartate receptors. As systematically administered ketamine is unlikely to produce the respiratory depression, it seemed to offer an obvious advantage over the narcotics in which major drawback is respiratory depression. Aims & Objective: (1) To study the following parameters in pregnant women given ketamine v/s pregnant women not given analgesic - (a) Maternal outcome in form of duration of labour, mode of delivery, complication of third stage of labour. (b) Foetal outcome in form of Apgar score at 1 min and 5 min. (2) To study pharmacological effect of ketamine on mother (3) To evaluate patient’s satisfaction about this method. Material and Methods: The present study was Randomized controlled trial, conducted in Department of Obstetrics and Gynaecology at Smt. SCL Municipal General Hospital affiliated to NHL Medical College Ahmedabad over a span of 3 yrs. from 2010 to 2012. Study included primigravida and multigravida. 100 women fulfilling the inclusion and exclusion criteria were taken for the study. Study population divided into Control Group (no drug administered) and Study group (intravenous ketamine administered). Results: The duration of 1st and 2nd stage was remarkably shortened in study group. 64% of parturient in study group delivered within 3 hours of entering the active phase of labour compared to only 10% in control group. In study group 98% delivered vaginally only 2% required instrumental delivery. There was no inhibition of bearing down reflex by ketamine, no maternal exhaustion in study group. In present study ketamine had no effect on APGAR score at 1 min & at 5 min. 30% had marginal rise in pulse rate with range of 10-15 beats /min. 16% had risen in B.P. not beyond 15-20 mm of Hg. 10% cases had nausea but no vomiting. 90% of cases had excellent pain relief & 8% had satisfactory pain relief, while 2% had no pain at all. Conclusion: The low dose intravenous ketamine suits best to this situation as it provides effective analgesia in low doses, safe without significant maternal and foetal complications, does not prolong duration of labour and there is no increase in rate of instrumental delivery or caesarean section rate. Since it reduces maternal pain thereby reducing the maternal exhaustion the patients on ketamine are very co-operative during labour, easy to administer and monitor without the help of an expertise and cost effective. KEY-WORDS Normal Labour; Intravenous Ketamine; Study Group; Control Group