A randomized, double blind study comparing fentanyl with ketamine for transient chest discomfort/pain during LSCS under spinal anesthesia

Objective: Intraoperative transient chest discomfort/pain is a common problem during lower segment cesarean section (LSCS), incidence ranging from 30-60 %. Only a few drugs are available to treat it due to concerns regarding maternal and fetal safety. Fentanyl is commonly used but has limited or no availability in most of India especially in rural areas. So we planned this study to compare ketamine as alternative to fentanyl to treat this chest discomfort/pain. Methodology: This prospective, randomized, double blind study was carried out on sixty patients aged above 18 years, of American Society of Anesthesiologist (ASA) grade I or II scheduled for elective LSCS under spinal anesthesia, who complained of chest discomfort/pain within 15 min of delivery of baby. The parturients were randomly divided into two groups. Group F to receive inj fentanyl 1 [micro]g/kg and Group K to receive inj ketamine 0.25 mg/kg intravenously immediately after complaining of chest discomfort/ pain. Duration of surgery, time of onset of pain, time required to relieve pain, hemodynamic parameters, adverse event and duration of postoperative analgesia were observed. The drugs were compared by using equivalence test; Two-One-Sided-Test (TOST). Results: There was no difference in demographic profile and baseline parameter in both groups. After drug administration chest discomfort/pain was relieved in both groups effectively in 1.15 [+ or -] 0.83 min vs. 1.23 [+ or -] 0.48 min in Group F and Group K respectively, without any significant adverse event. Conclusion: Low dose ketamine can be used as alternative to fentanyl for transient retrosternal chest discomfort/pain during LSCS. Key words: Retrosternal chest discomfort; Fentanyl; Ketamine