BACKGROUND:

Spinal anesthesia with bupivacaine has been the most preferred mode of anaesthesiafor  lower abdominal surgeries owing to itsinherent advantages. Various adjuvantslike fentanyl and ketamine are used with local anaesthetic agents in spinal anaesthesia to improve quality of anaesthesia, prolong postoperative analgesia, and decrease side effects.

AIM  The purpose of this study was to compare the efficacy, onset and duration of sensory and motor block , degree of postoperative analgesia and possible side effects of intrathecal bupivacaine (0.5%) with ketamine and intrathecal bupivacaine (0.5%) with fentanyl in patients scheduled for total abdominal hysterectomy.

MATERIALS AND METHODS: This prospective, randomized double blind, study included 72 ASA class I and II patients undergoing total abdominal hysterectomy under spinal anaesthesia. The patients were randomly divided in two groups of 36 each using a chit in box method.: Group BF(bupivacaine fentanyl group): 3 ml of 0.5% hyperbaric bupivacaine  and 25 μg fentanyl.  Group BK(bupivacaine ketamine group): 3 ml of 0.5% hyperbaric bupivacaineand  25 mg ketamine.

RESULTS: The onset of sensory block was earlier in group BK  as compared to group BF. Mean time of onset of motor block in group BF was 1.81 + 0.46 minutes and for group BK was 1.24+ 0.44. The duration of sensory block and postoperative analgesia  was longer in Group BF.  The mean duration of motor block was 131.33 ± 10.82 minutes in group BF  and 120.69 ± 6.61 minutes in group BK. Itraoperative adverse effects were not significant in both the groups.

CONCLUSIONS: Addition of ketamine leads to rapid onset of both sensory and motor blockade whereas addition of fentanyl prolongs the duration of sensory blockade providing longer period of analgesia