A comparison of different doses of spinal levobupivacaine combined with S-ketamine and clonidine for elective caesarean section: A prospective, randomized and double-blinded study.
Ahmed Mostaffa MD, Ehab Elshahat MD, Mohamed Elrabeiy MD, and Mohamed Hamed MD,.
Anesthesia and ICU department, Benha university
Abstract:
Objectives:This study aimed to investigate the block characteristics and adverse effects of using different doses of spinal plain levobupivacaine combined withS-ketamine and clonidine during caesarean section.
Patients and methods:This prospective randomized, controlled and double blind clinical trial was conducted on 120 female patients scheduled for elective caesarean section were randomly allocated into three equal groups:Group I received intrathecal 10mg levobupivacaine 0.5% with(12.5 mg S-ketamine + 25 μg clonidine); Group II received intrathecal 7.5mg levobupivacaine 0.5% with (12.5 mg S-ketamine + 25 μg clonidine)and Group III received intrathecal 5mg levobupivacaine 0.5% (12.5 mg S-ketamine + 25 μg clonidine).Hemodynamic parameters, the onset of the sensory block,the level of the sensory blockade, the duration of the sensory block, the duration of the motor blockade, the quality of intraoperative analgesia and the presence of side effects were recorded.
Results:
Comparison of the onset and duration of sensory block did not reveal any significant differences among the groups.Duration of motor blockade and time to first analgesic request was significantly longer in group I, as compared to groups II and III and in group II as compared to group III.The incidence of intraoperative nausea, vomiting, pruritus and shivering were comparable in all groups.Regarding hypotension, significant reduction in the incidence of hypotension in group III compared to group I and II. Regarding bradycardia, there was a significant reduction in the incidence of bradycardia with decreasing the dose of levobupivacaine (Group III showed the least incidence).
Conclusion:Spinal anaesthesia using small doses of levobupivacaine with combination of S –ketamine, clonidine was effective in caesarean section both Intraoperative and postoperative with less adverse effects.
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