Pre - emptive epidural analgesia with bupivacaine, deltiazem and ketamine singly or in combination - A Randomised Trial.

ABSTRACT

Background: A randomized control study was designed to compare postoperative epidural analgesia by preemptive use of epidural administration of local anesthetic- bupivacaine alone and in combination with NMDA blocker- ketamine or calcium channel blocker- diltiazem singly or both in combination . Medhods Sixty female patients in age group 35-50 yrs with ASA grade I and II, posted for open abdominal hysterectomy were randomly distributed in four groups after ethical committee approval and written consent. They were given epidurally 0.4 ml /kg of 0.5 % Bupivacaine in Control group, 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5mg in BK group , 0.4 ml /kg of 0.5 % Bupivacaine + Diltiazem 10 mg in BD group and 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5 mg + Diltiazem 10 mg in BKD group. Results: BK group had significant pain free period (8.8 ± 1.37) post operatively as compared to rest three groups (P < 0.01). BD group (5.8 ± 0.94) also had comparable pain relief.BKgroup needed three to four number of top-up's in first 24 hours (3.37 ± 0.46) where as BD group needed five to seven number of top-up's in next 24 hours (5.93 ± 0.70) (P < 0.01). BK group and BKD group patients were sedated resulting in reduced number of top-ups required in first 24 hours. Conclusion: Ketamine and diltiazem were found to be synergetic with bupivacaine for preemptive epidural analgesia. Diltiazem was better option over ketamine when sedation is not desirable.