///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

THE ASSOCIATION BETWEEN LOW DOSE INTRAVENOUS KETAMINE DURING CESAREAN DELIVERY, CHRONIC PAIN, AND POSTPARTUM DEPRESSION

Abstract Number: 3
Abstract Type: Original Research

Laurie A. Chalifoux M.D.1 ; Paloma Toledo M.D.2; Anne Lyons D.O.3; Jeanette Bauchat M.D.4; Cynthia Wong M.D.5

Introduction: Low-dose ketamine (0.15mg/kg) administration has been shown to be effective in decreasing morphine requirements in the first 24 hours after surgery.1 A single sub-anesthetic dose (10 mg) of intravenous (IV) ketamine in combination with intrathecal morphine and IV ketorolac exhibited a decrease in the incidence of pain at 2 weeks postpartum in cesarean delivery (C/D) patients.2 In this randomized, placebo-controlled, double-blind trial we hypothesized that patients who received a single dose of IV ketamine (10mg) during C/D may be less likely to develop postpartum depression or chronic pelvic pain.

Methods: Parturients scheduled for C/D under spinal anesthesia were recruited. Spinal anesthesia consisted of bupivacaine 12mg, fentanyl 15cg, and morphine 150cg. Postpartum, subjects received either IV ketamine 10 mg (KET) or saline (SAL). Post-operative analgesia consisted of scheduled IV ketorolac. Breakthrough pain was treated with acetaminophen 325 mg/hydrocodone 10mg. Parturients were called 1year later to assess pain and self-reported diagnosis of depression at 6 wks and 1 year postpartum. Pain was rated on a numeric rating scale (0-10). Groups were compared using a two-tailed t-test. P<0.05 was considered significant.

Results: 82 patients participated. Pain scores were lower in the KET group at 6 wks postpartum than in the SAL group. This difference did not persist at 1 year postpartum. No difference was seen in the incidence of postpartum depression at 6 wks or at 1 year after delivery.

Conclusion: We found that a single low-dose of ketamine had a persistent analgesic effect until 6 wks postpartum. However, there was no difference in chronic pain or depression. It is possible that this is due to the low ketamine dose, or that a difference exists and we were underpowered to detect this difference.

References: 1. Bell RF et al. Cochrane Database Syst Rev 2006. Issue 1. Art. No.: CD004603.pub2. DOI: 10.1002/14651858.CD004603.pub2.

2. Bauchat JR et al. Anesthesiology 2009; A1345.



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