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Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients

Published online by Cambridge University Press:  23 December 2004

T. Togal ,
S. Demirbilek ,
A. Koroglu ,
E. Yapici  and
O. Ersoy
T. Togal
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
S. Demirbilek
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
A. Koroglu
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
E. Yapici
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
O. Ersoy
Affiliation:
Inonu University School of Medicine, Department of Anaesthesia, Malatya, Turkey
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Abstract

Summary

Background and objective: Intrathecal ketamine as the sole anaesthetic agent has demonstrated a lack of cardiovascular depression that should be of advantage in an elderly population. S(+) ketamine has three-times the analgesic potency of R(−) ketamine and its antinociceptive effects after intrathecal administration in rats are known. We decided to evaluate the effects of intrathecal S(+) ketamine added to a small dose of spinal bupivacaine in elderly patients undergoing transurethral prostate surgery.

Methods: Forty males over 60 yr old, scheduled for transurethral prostate resection under spinal anaesthesia, were studied in a prospective, double-blinded, randomized way. Patients were allocated to receive either bupivacaine 10 mg or bupivacaine 7.5 mg combined with S(+) ketamine 0.1 mg kg−1. Spinal block onset time, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded.

Results: Onset times of motor and sensory block were shorter in the bupivacaine plus S(+) ketamine group. Incomplete motor block of the lower extremities was seen in 80% of the patients in bupivacaine plus S(+) ketamine group. Duration of complete motor block and spinal analgesia was shorter in the bupivacaine plus S(+) ketamine group. There was no significant difference in arterial pressure. Heart rate decreased after spinal anaesthesia in the bupivacaine plus S(+) ketamine group and was significantly lower until the end of anaesthesia. The incidence of adverse effects was not different between groups.

Conclusions: Intrathecal S(+) ketamine administered with a low dose of bupivacaine provides shorter motor and sensory block onset time, shorter duration of action and less motor blockade in elderly males.

Keywords

ANAESTHESIA, spinalANAESTHETICS, LOCAL, bupivacaineANALGESICS, NON-NARCOTIC, ketamineISOMERISM, stereoisomerism
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 3 , March 2004 , pp. 193 - 197
Copyright
2004 European Society of Anaesthesiology

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