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Clinical Trials/NCT02515422
NCT02515422CompletedPhase 1

Subcutaneous Wound Infiltration of Ketamine is Superior to Bupivacaine in Terms of Pain Perception and Opioid Consumption After Cesarean Section: a Double-blinded Randomized Placebo Controlled Clinical Trial.

Huseyin Aksoy1 site in 1 country120 target enrollmentStarted: June 2014Last updated:
Conditions
Interventions
Drugs

Trial Snapshot

Phase
Phase 1
Status
Completed
Enrollment
120
Locations
1
Primary Endpoint
Postoperative visual analog scale pain score

Study Overview

Brief Summary

Aim: To assess the analgesic efficacy of subcutaneous infiltration of ketamine, either alone or as an adjuvant to bupivacaine, following CS and to compare their effects on postoperative pain scores and opioid consumption.

Methods: Included patients were allocated to four treatment groups using computer-generated randomization number chart as follows; Group 1 (Ketamine, n=30) received subcutaneous infiltration of ketamine, Group 2 (Bupivacaine, n=30) received subcutaneous infiltration of bupivacaine 0.5%, Group 3 (Ketamine+Bupivacaine, n=30) received subcutaneous infiltration of ketamine+bupivacaine 0.5% and Group 4 (Placebo, n=30) received subcutaneous infiltration of placebo (0.9% saline solution). Patients, anesthetist, surgeon, and other medical and nursing staff were blinded to the contents of the medications. VAS scores at resting and on coughing and analgesic consumptions were compared.

Detailed Description

the Group 1 (Ketamine, n=30) received subcutaneous infiltration of ketamine 1 mg/kg (Ketalar®, 10 mL inj., 50 mg ketamine hydrochloride/ml, Pfizer Drug Company, USA). The Group 2 (Bupivacaine, n=30) received subcutaneous infiltration of 20 mL (100 mg) of bupivacaine 0.5% (Marcaine®, 20 mL inj. 5 mg bupivacaine hydrochloride/ml, AstraZeneca Drug Company, Turkey). The Group 3 (Ketamine+Bupivacaine, n=30) received subcutaneous infiltration of ketamine 1 mg/kg (Ketalar®) plus subcutaneous infiltration of 20 mL (100 mg) of bupivacaine 0.5% (Marcaine®). The Group 4 (Placebo, n=30) received subcutaneous infiltration of 30 mL placebo (0.9% saline solution). All medications were diluted with sterile 0.9% saline solution to 30 ml solutions in the similar volume and shape syringes and were infiltrated subcutaneously along the skin wound edges and close to the fascia prior to skin closure. There were four separate syringes which were prepared by an anesthesiology technician for four different treatment groups labeled G1, G2, G3 and G4 containing the ketamine, bupivacaine, ketamine plus bupivacaine and normal saline solution. Patients, anesthetist, surgeon, and other medical and nursing staff were blinded to the contents of the medications.

Study Design

Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel
Primary Purpose
Supportive Care
Masking
Triple (Participant, Investigator, Outcomes Assessor)

Eligibility Criteria

Ages
18 Years to — (Adult, Older Adult)
Sex
Female
Accepts Healthy Volunteers
Yes

Inclusion Criteria

  • singleton term pregnancy,
  • between 38-41th weeks of gestation,
  • absence of any medical or obstetrical problems.

Exclusion Criteria

  • multiple pregnancies,
  • intrauterine fetal deaths,
  • active stage of labor,
  • obstetric emergencies such as antepartum hemorrhage, eclampsia and acute fetal distress,
  • special request for general anesthesia,
  • history of allergic reaction or sensitivity to any of the drugs used in the study,
  • reflected anxiety and depression during the cesarean operation,
  • any systemic diseases (chronic hypertension, thyroid diseases, renal or hepatic insufficiency, psychiatric disorders,
  • chronic pain syndrome, epilepsy or intracranial hypertension)
  • medications that would affect the perception of pain,
  • current or past history of narcotic use or a history of narcotic abuse,
  • inability to understand how to score a 10-cm visual analogue scale (VAS) for pain.

Arms & Interventions

Group 1, Ketamine

Active Comparator

Ketamine, 1 mg/kg (Ketalar®, 10 mL inj., 50 mg ketamine hydrochloride/ml, Pfizer Drug Company, USA) was administered subcutaneously before the closure of pfannenstiel incision.

Intervention: Ketamine (Drug)

Group 2, Bupivacaine

Active Comparator

Bupivacaine 0.5% 20 mL (100 mg) (Marcaine®, 20 mL inj. 5 mg bupivacaine hydrochloride/ml, AstraZeneca Drug Company, Turkey) was administered subcutaneously before the closure of pfannenstiel incision.

Intervention: Bupivacaine (Drug)

Group 3, Ketamine+Bupivacaine

Active Comparator

Ketamine 1 mg/kg (Ketalar®) and bupivacaine 0.5% (100 mg) (Marcaine®) were administered subcutaneously before the closure of pfannenstiel incision.

Intervention: Ketamine (Drug)

Group 3, Ketamine+Bupivacaine

Active Comparator

Ketamine 1 mg/kg (Ketalar®) and bupivacaine 0.5% (100 mg) (Marcaine®) were administered subcutaneously before the closure of pfannenstiel incision.

Intervention: Bupivacaine (Drug)

Group 4, Placebo

Placebo Comparator

Placebo (0.9% saline solution) was administered subcutaneously before the closure of pfannenstiel incision.

Intervention: Placebo (0.9% saline solution) (Drug)

Outcomes

Primary Outcomes

Postoperative visual analog scale pain score

Time Frame: Postoperative 12 hours

Secondary Outcomes

  • Postoperative opioid consumption(Postoperative 12 hours)

Investigators

Sponsor Class
Other Gov
Responsible Party
Sponsor Investigator
Principal Investigator

Huseyin Aksoy

M.D.

Kayseri Education and Research Hospital

Study Sites (1)

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