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OBJECTIVE: Delayed neurocognitive recovery is an objectively measurable decline in the cognitive status at varying intervals after surgery under both general and spinal anaesthesia. In this study, we used the Short Portable Mental Status Questionnaire to evaluate the protective effect of ketamine infusion on cognitive function of elderly patients undergoing spinal anaesthesia for orthopaedic procedures. METHODS: A randomised, double-blinded placebo-controlled trial. Forty-two geriatric patients listed for elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive an intravenous infusion of either ketamine (0.3mg/kg) or isotonic saline (control group) after receiving spinal anaesthesia, which continued throughout the procedure. Cognitive performance was evaluated, as a primary outcome, with Short Portable Mental Status Questionnaire. RESULTS: Baseline cognitive performance was comparable in both groups. Patients in the ketamine group showed statistically significant fewer errors in the postoperative Short Portable Mental Status Questionnaire compared with the baseline evaluations (p = 0.038). Patients in the ketamine group showed significantly lower verbal numerical scale scores than the control group (p = 0.04) at six hours after surgery. CONCLUSION: Elderly patients undergoing spinal anaesthesia showed a better cognitive status after receiving an intravenous infusion of 0.3mg/kg ketamine. However, further research with a larger sample size and different assessment tools might be required to verify our results.
RESUMO
BACKGROUND: Shoulder pain is a commonly observed but mostly neglected consequence of cesarean section and little is known as well as explored about intraoperative shoulder pain. We conducted this randomized prospective double-blinded study to evaluate the efficacy of ketorolac in reducing the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section. METHODS: Two hundred ASA I and II patients scheduled to undergo elective cesarean section under spinal anesthesia were randomized to receive either intravenous ketorolac 30 mg (ketorolac group) or normal saline (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were severity of intraoperative shoulder pain, amount of intraoperative blood loss, incidence of hypotension, bradycardia and request for intraoperative rescue analgesia. RESULTS: The incidence of intraoperative shoulder pain in the control group was significantly higher than the ketorolac group (P = 0.003). Severity of shoulder pain and requests for intraoperative analgesia was significantly higher in the control group (P = 0.012, P = 0.006 respectively). Patients in the Ketorolac group experienced significantly higher incidences of bradycardia (P = 0.037). CONCLUSION: 30 mg ketorolac administered intravenously just before the operation could decrease incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov (Registration number: NCT02380898, first registered in 01/03/2015).
