Evaluation of Oral Ketamine for Pain Relief During Perineal Repair in Postpartum Women South-East Nigeria
Journal Title: Journal of Medical Science And clinical Research - Year 2014, Vol 2, Issue 6
Abstract
Background: We evaluated the efficacy of oral Ketamine for pain relief during perineal repairs in postpartum women with episiotomies, perineal tears and cervical laceration. Method: A prospective, non-placebo, single blind randomised study was carried out. Two hundred and seventy three (273) booked parturients in active phase of labour were randomly assigned to three treatment groups (A-C). The dosages of oral Ketamine that they received were as follows: Group A- 4 mgkg-1 ; group B- 5 mgkg-1 ; and group C- 6 mgkg-1 . Of the 273 parturients that received the oral ketamine, 111 of the parturients had perineal laceration and/or episotomy. The efficacy of the drug for suturing episiotomy and vaginal laceration was determined by suturing without infilteration of local anaesthetic (Lidocaine) and assessed for pain using pain assessment tools (visual analogue scale, VAS and verbal rating scale, VRS). Patients with VAS ≥3 and VRS≥3 were infiltrated with 2% Lidocaine with adrenaline (1-7mgkg-1 as rescue Okorie O, Babah OA JMSCR Volume 2 Issue 6 June 2014 Page 1359 JMSCR Volume||2||Issue||6||Page 1358-1363 ||June 2014 2014 analgesia during episiotomy and vaginal laceration repair. Result: The proportion of women who reported satisfaction to varying degrees during repair of their perineal laceration and/or episiotomy was 66.7% in group A, 42.9% in group B, and none in group C. Rescue analgesia was required in 92.3% of patients in group A, 90.5% for those in group B and 58.3% for those in group C Conclusion: The higher the dose the better the analgesia during the perineal repairs. However the dosage should be adjusted such as to minimize the incidence of side effects and improve patient’s satisfaction. Probably if the half dose of oral Ketamine that gave maximum satisfaction (4mgKg-1 ) is given 15 minutes before the procedure, then this might minimize the need for rescue analgesia. This however calls for further studies.
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Okorie O
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