Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-28T01:55:55.345Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients

Published online by Cambridge University Press:  23 December 2004

T. Togal ,
S. Demirbilek ,
A. Koroglu ,
E. Yapici  and
O. Ersoy
T. Togal
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
S. Demirbilek
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
A. Koroglu
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
E. Yapici
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
O. Ersoy
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
Get access

Abstract

Summary

Background and objective: Intrathecal ketamine as the sole anaesthetic agent has demonstrated a lack of cardiovascular depression that should be of advantage in an elderly population. S(+) ketamine has three-times the analgesic potency of R(−) ketamine and its antinociceptive effects after intrathecal administration in rats are known. We decided to evaluate the effects of intrathecal S(+) ketamine added to a small dose of spinal bupivacaine in elderly patients undergoing transurethral prostate surgery.

Methods: Forty males over 60 yr old, scheduled for transurethral prostate resection under spinal anaesthesia, were studied in a prospective, double-blinded, randomized way. Patients were allocated to receive either bupivacaine 10 mg or bupivacaine 7.5 mg combined with S(+) ketamine 0.1 mg kg−1. Spinal block onset time, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded.

Results: Onset times of motor and sensory block were shorter in the bupivacaine plus S(+) ketamine group. Incomplete motor block of the lower extremities was seen in 80% of the patients in bupivacaine plus S(+) ketamine group. Duration of complete motor block and spinal analgesia was shorter in the bupivacaine plus S(+) ketamine group. There was no significant difference in arterial pressure. Heart rate decreased after spinal anaesthesia in the bupivacaine plus S(+) ketamine group and was significantly lower until the end of anaesthesia. The incidence of adverse effects was not different between groups.

Conclusions: Intrathecal S(+) ketamine administered with a low dose of bupivacaine provides shorter motor and sensory block onset time, shorter duration of action and less motor blockade in elderly males.

Keywords

ANAESTHESIA, spinalANAESTHETICS, LOCAL, bupivacaineANALGESICS, NON-NARCOTIC, ketamineISOMERISM, stereoisomerism
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 3 , March 2004 , pp. 193 - 197
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996; 51: 1139–1143.Google Scholar
Bion JF. Intrathecal ketamine for war surgery. A preliminary study under field conditions. Anaesthesia 1984; 39: 1023–1028.Google Scholar
Hawksworth C, Serpell M. Intrathecal anesthesia with ketamine. Reg Anesth Pain Med 1998; 23: 283–288.Google Scholar
Kathirvel S, Sadhasivam S, Saxena A, Kannan TR, Ganjoo P. Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia. Anaesthesia 2000; 55: 899–904.Google Scholar
Klimscha W, Horvaath G, Szikszay M, Bobos I, Benedek G. Antinociceptive effects of the S(+) enantiomer of ketamine on carrageenan hyperalgesia after intrathecal administration in rats. Anesth Analg 1998; 86: 561–565.Google Scholar
Islas JA, Astorga J, Laredo M. Epidural ketamine for control of postoperative pain. Anesth Analg 1985; 64: 1161–1162.Google Scholar
Gebhardt B. Pharmacology and clinical results with peridural and intrathecal administration of ketamine. Anaesthesist 1994; 43: 34–40.Google Scholar
White PF, Schuttler J, Shafer A, Stanski DR, Horai Y, Trevor AJ. Comparative pharmacology of the ketamine isomers. Studies in volunteers. Br J Anaesth 1985; 57: 197–203.Google Scholar
Adams HA, Thiel A, Jung A, Fengler G, Hempelmann G. Studies using S(+)-ketamine on probands. Endocrine and circulatory reactions, recovery and dream experiences. Anaesthesist 1992; 41: 588–596.Google Scholar
Lauretti GL, Oliveira AM, Rodrigues AM, Cleber AJ, Paccola CA. The effect of transdermal nitroglycerine on spinal S(+)-ketamine antinociception following orthopedic surgery. J Clin Anesth 2001; 13: 576–581.Google Scholar
Himmelseher S, Ziegler-Pithamitsis D, Argiriadou H, Martin J, Jelen-Esselborn S, Kochs E. Small-dose S(+)-ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty. Anesth Analg 2001; 92: 1290–1295.Google Scholar
Chia YY, Liu K, Liu YC, Chang HC, Wong CS. Adding ketamine in a multimodal patient-controlled epidural regimen reduces postoperative pain and analgesic consumption. Anesth Analg 1998; 86: 1245–1249.Google Scholar
Naguib M, Sharif MY, Seraj M, El Gammel M, Dawlatly KA. Ketamine for caudal analgesia in children: comparison with caudal bupivacaine. Br J Anaesth 1991; 67: 559–564.Google Scholar
Yanli Y, Eren A. The effect of extradural ketamine on onset time and sensory block in extradural anaesthesia with bupivacaine. Anaesthesia 1996; 51: 84–86.Google Scholar
Gantenbein M, Abat C, Attolini L, Pisano P, Emperaire N, Bruguerolle B. Ketamine effects on bupivacaine local anaesthetic activity and pharmacokinetics of bupivacaine in mice. Life Sci 1997; 61: 2027–2033.Google Scholar
Weir PS, Fee JP. Double-blind comparison of extradural block with three bupivacaine–ketamine mixtures in knee arthroplasty. Br J Anaesth 1998; 80: 299–301.Google Scholar