Comparative evaluation of safety and efficacy of epidural bupivacaine with morphine and ketamine vs epidural bupivacaine with morphine alone for post-operative analgesia

Background: Adding a small-dose of ketamine provides better postoperative analgesia and reduces morphine consumption after major abdominal surgery. Psychomimetic effects are the most troubling side-effects of ketamine. Hence evaluation of the safety and efficacy of adding ketamine to epidural bupivacaine with morphine is the need of the hour. Materials and methods: The study was a randomized controlled trial conducted in the Department of Anesthesia, Department of Anesthesiology, Government Mohan Kumaramangalam Medical College and Hospital between April 2015 to March 2016. Study on 60 subjects of ASA I and II category randomized into two groups undergoing elective abdominal surgeries was done. 30 subjects in the study group received ketamine 0.2 mg/kg in addition to epidural morphine 0.05 mg/kg with 0.125% bupivacaine alone received in the control group for post-operative analgesia. The subjects were monitored for 24 hours. Results: The mean time for onset of analgesia and median duration of analgesia was 6.10 ± 1.27 minutes, 13.73 ± 3.10 hours respectively in ketamine group (Group I) whereas it was 12.53 ± 2.08 minutes, 8.27 ± 1.08 hours respectively in the control group. There was no complication or ketamine related side effects in the ketamine group compared to one in the control group. Conclusions: A multimodal combination comprising of low-dose epidural ketamine with morphine not only results in effective postoperative analgesia but also decreases the rescue analgesia requirement, without any increase in side-effects.