الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
Aim of the work
The aim of the work is to evaluate the postoperative analgesic effects of intrathecal morphine versus intrathecal ketamine after lower extremity surgery.
Summary and Conclusion.
The study was carried out in El Minia University Hospital during the period from October 2007 to July 2008. The study involved sixty patients of either sex, ASA physical status I-II scheduled for elective lower limb orthopedic surgery under spinal anesthesia.
The aim of our study was to study the postoperative analgesic effects of intrathecal morphine versus ketamine after lower extremity surgery. Patients were randomly allocated into three equal groups (20 patient each).
*Group 1 (control group) patients received intrathecal bupivacaine 0.5% plus 0.5 ml. of physiological saline 0.9%.
*Group 2 (Morphine group) patients received intrathecal bupivacaine 0.5% plus 0.1 mg. morphine in 1\2 ml. physiological saline 0.9%
*Group 3 (Ketamine group) patients received intrathecal bupivacaine 0.5% plus 0.1 mg. / kg. ketamine.
The dose of bupivacain was always the same (15mgl).
The study parameters including VAS, time of first analgesic request, total analgesic consumption of Tenoxicame (20 mg.\ampule) , hemodynamic variables (blood pressure, pulse, oxygen saturation) and occurrence of any intraoperative or postoperative adverse effects such as vomiting, itching, hypotention or respiratory depression.
Postoperative I.V. Tenoxicame (20 mg.\ampule) was given as a rescue analgesic when postoperative VAS ≤ 4.
The results of this study demonstrated that the addition of morphine and ketamine to bupivacaine increase its analgesic effect.
The results of this study demonstrated that there was statistical significant reduction in the postoperative VAS in morphine group in comparison to both ketamine and control group.
The time of first analgesic request was delayed in Group 2 (8.8 ± 0.8 hr.) in comparison to both Group 3 (5.8± 0.45 hr.) and control Group (4.3 ± 0.47 hr.).
As regard Tenoxicame (20 mg.\ampule) consumption during the first 24 hrs. following surgery, there was statistical significant reduction in Group 2 and 3 (22 ± 7.2\ 32 ± 10 mg.) compared with the control Group (46 ± 9.4 mg.).
From this study, there was statistical significant difference as regard hemodynamics in Group 3 in comparison to Group 2 , as ketamine preserved the hemodynamic stability.
There was significant difference in between the three groups as regard adverse effects like nausea and vomiting and occurred in group 2 and 3 while pruritis occurred in Group 2 and did not occurred in either Group 3 or control Group.
Respiratory depression did not occur in any one of the patients of the three groups.
Conclusion
We concluded that 0.1 mg. of intrathecal morphine added to bupivacaine provides excellent postoperative analgesia in the first 24-h, as it does not cause significant adverse effects mainly respiratory depression ,while 0.1mg\kg ketamine added to bupivacaine provides less postoperative analgesia in the first 24-h, but with preservation of hemodynamic stability.