Abstract
Background: Obstetric anesthesia is demanding but gratifying subspecialty of anesthesiologist. Anesthetic care of pregnant patient is unique in that two patients are cared for simultaneously; the parturient and the fetus. Aim of Study: The aim of our study was to compare between the two preparations and also to know if one preparation has advantage over the other regarding the onset, duration and recovery of sensory and motor blocked, duration of analgesia, hemodynamics changes, respiratory changes, and incidence of side effects Patients and Methods: A randomized double blinded controlled clinical trial conducted in the department of obstetrics & gynecology of Maternity teaching hospital in Erbil city over a period of 5 months from (1st of Sept .2012 to 1st Feb.2013). This study was conducted on 40 parturient of ASA physical status I and ASA II, in the age group of 17 to 46 years, planed for caesarean section under subarachnoid block were included in the study. Patients with any contraindication to spinal anesthesia, or patients with history of allergy to opioids/local anesthetics/Ketamine excluded.They were randomly divided into two groups of 20 patients each: Group-F (12.5 mg hyperbaric bupivacaine 0.5% + 25μg Fentanyl) and Group-K (12.5 mg hyperbaric bupivacaine 0.5% + 50 mg ketamine) by the sealed envelope technique after taking informed consent. Results : Intrathecal ketamine with bupivacaine as compared to fentanyl with bupivacaine produced faster onset of sensory block ( 63.1sec vs 69sec ), longer Time for first analgesic (176.1 min vs 141.3 min) with better hemodynamic stability. The incidence of nystagmus is more with intrathecal ketamine (20% vs 0%) and pruritis is more with intrathecal fentanyl (0% vs 30%).Conclusions: Intrathecal ketamine is a better adjuvant to Bupivacaine than intrathecal fentanyl in patients undergoing CS under subarachnoid block. Thus it is safe modality for the parturient undergoing caesarean section, but central side effects like, nystagmus can occur in some patients