Mahdi Ammar H, Kahloul Mohamed, Mohammed Myasar J, Mohammed Abbas K
Department of Anesthesia and Intensive Care, Faculty of Medicine of Sousse, University of Sousse, Sousse, TUN.
Department of Anesthesia and Intensive Care, Bilad Alrafidain University College, Baqubah, IRQ.
Cureus. 2024 Feb 23;16(2):e54776. doi: 10.7759/cureus.54776. eCollection 2024 Feb.
Spinal anesthesia offers numerous advantages and desirable features. However, it is associated with various side effects related to local anesthetic agents used. Reducing the dose of local anesthetic in spinal anesthesia can help minimize side effects but may lead to a diminished analgesic effect or failure of anesthesia. Therefore, adding an adjuvant may enhance the benefits while mitigating side effects.
This study aimed to evaluate the effects of ketamine and tramadol as adjuvants to bupivacaine on the duration of spinal analgesia. The objectives were to compare the three groups and prove their analgesic effects, safety, and superiority. The primary outcomes were the duration of spinal analgesia, as well as the onset and duration of both sensory and motor blocks. Secondary outcomes included the heart rate, mean arterial pressure, and the incidence of undesired effects such as nausea, vomiting, sedation, shivering, and postoperative headache.
In this double-blind randomized controlled trial, 120 female patients undergoing elective open unilateral ovarian cystectomy under spinal anesthesia were studied. The inclusion criteria included patients aged 16-45 years with a physical status classified as American Society of Anesthesiologists (ASA) class I and II. Patients were randomly allocated into three groups: group B (n=40) received only bupivacaine, group BK (n=40) received bupivacaine mixed with preservative-free ketamine, and group BT (n=40) received bupivacaine mixed with preservative-free tramadol.
The mean duration of spinal analgesia, measured in minutes, showed significant differences (P < 0.001) between group BK (165 ± 4) and group B (170 ± 5). There was also a significant difference between group BT (313 ± 8) and group B (170 ± 5) (P < 0.001). Additionally, significant differences were observed between group BK (165 ± 4) and group BT (313 ± 8) (P < 0.001).
The administration of 25 mg of ketamine and 25 mg of tramadol as adjuvants to bupivacaine in spinal anesthesia significantly affected the postoperative duration of analgesia. Tramadol prolonged the duration of spinal anesthesia, while ketamine shortened it. The use of both adjuvants did not result in undesired effects.
脊髓麻醉具有诸多优点和理想特性。然而，它与所用局部麻醉剂相关的各种副作用有关。在脊髓麻醉中减少局部麻醉剂的剂量有助于将副作用降至最低，但可能会导致镇痛效果减弱或麻醉失败。因此，添加佐剂可能会增强益处并减轻副作用。
本研究旨在评估氯胺酮和曲马多作为布比卡因佐剂对脊髓镇痛持续时间的影响。目标是比较三组并证明它们的镇痛效果、安全性和优越性。主要结局是脊髓镇痛的持续时间，以及感觉和运动阻滞的起效时间和持续时间。次要结局包括心率、平均动脉压以及恶心、呕吐、镇静、寒战和术后头痛等不良事件的发生率。
在这项双盲随机对照试验中，研究了120例接受脊髓麻醉下择期开放性单侧卵巢囊肿切除术的女性患者。纳入标准包括年龄在16 - 45岁、美国麻醉医师协会（ASA）身体状况分级为I级和II级的患者。患者被随机分为三组：B组（n = 40）仅接受布比卡因，BK组（n = 40）接受布比卡因与无防腐剂氯胺酮的混合液，BT组（n = 40）接受布比卡因与无防腐剂曲马多的混合液。
以分钟为单位测量的脊髓镇痛平均持续时间在BK组（165 ± 4）和B组（170 ± 5）之间显示出显著差异（P < 0.001）。BT组（313 ± 8）和B组（170 ± 5）之间也存在显著差异（P < 0.001）。此外，BK组（165 ± 4）和BT组（313 ± 8）之间观察到显著差异（P < 0.001）。
在脊髓麻醉中，将25毫克氯胺酮和25毫克曲马多作为布比卡因的佐剂使用，对术后镇痛持续时间有显著影响。曲马多延长了脊髓麻醉的持续时间，而氯胺酮缩短了它。两种佐剂的使用均未导致不良事件。
