Subcutaneous wound infiltration of ketamine versus bupivacaine in pain perception and opioid consumption after cesarean section: A randomized controlled trial
DOI:
https://doi.org/10.37800/RM.3.2026.810Keywords:
Cesarean section; ketamine; subcutaneous infiltration; postoperative pain; bupivacaine; opioid-sparing analgesiaAbstract
Relevance: Pain after cesarean delivery can be difficult to control and may require additional medication. Since opioids are associated with several unwanted effects, other methods of pain relief are being explored. While intravenous and intrathecal ketamine have been studied extensively, the analgesic role of subcutaneous ketamine infiltration at the surgical wound site remains under-investigated.
The study aimed to evaluate the analgesic efficacy and safety of subcutaneous ketamine infiltration compared to bupivacaine and placebo in women undergoing elective cesarean section under spinal anesthesia.
Materials and Methods: A prospective, randomized, controlled trial was conducted at Kasr Al-Ainy University Hospital, Egypt, involving 120 parturients scheduled for elective cesarean section. Participants were randomized equally into three groups (n = 40 each): ketamine (1 mg/kg), bupivacaine (20 mL of 0.5% bupivacaine), or control (no wound infiltration). The allocated medication was infiltrated subcutaneously along the surgical wound immediately before skin closure. We assessed postoperative pain using the Visual Analog Scale (VAS) at 15 minutes, 60 minutes, 2 hours, 6 hours, 12 hours, and 24 hours after surgery.
Results: The ketamine group showed significantly lower VAS scores in the first 6 hours postoperatively. The mean time to first analgesic request was significantly longer in the ketamine group (5.3 ± 0.7 hours) compared to the bupivacaine (4.1 ± 0.8 hours) and control groups (2.9 ± 0.7 hours) (p < 0.001). Total 24-hour diclofenac consumption was lowest in the ketamine group (91.9 ± 31.7 mg). All participants required diclofenac sodium for rescue analgesia, whereas none required opioid analgesia. No significant adverse effects were observed.
Conclusion: Subcutaneous infiltration of ketamine significantly reduces early postoperative pain, delays analgesic requirement, and lowers overall analgesic consumption after cesarean section. It is a safe, simple, and effective technique suitable for routine use in multimodal analgesia protocols.
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