{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:54:22Z","timestamp":1792130062397,"version":"4.4.0"},"reference-count":34,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,6,2]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study aimed to determine if low dose intravenous ketamine is effective in reducing opioid use and pain after non-elective caesarean delivery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective, randomised, double-blind.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Tertiary hospital, Bisheshwar Prasad Koirala Institute of Health Sciences, Dharan, Nepal<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>80 patients undergoing non-elective caesarean section with spinal anaesthesia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Patients were allocated in 1:1 ratio to receive either intravenous ketamine 0.25\u2009mg\/kg or normal saline before the skin incision.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>The primary outcome was the total amount of morphine equivalents needed up to postoperative 24 hours. Secondary outcome measures were postoperative pain scores, time to the first perception of pain, maternal adverse effects (nausea, vomiting, hypotension, shivering, diplopia, nystagmus, hallucination) and neonatal Apgar score at 1 and 5\u2009min, neonatal respiratory depression and neonatal intensive-care referral.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The median (range) cumulative morphine consumption during the first 24 hours of surgery was 0 (0\u20134.67)\u2009mg in ketamine group and 1 (0\u20136)\u2009mg in saline group (p=0.003). The median (range) time to the first perception of pain was 6 (1\u201312) hours and 2 (0.5\u20136)\u2009hours in ketamine and saline group, respectively (p&lt;0.001). A significant reduction in postoperative pain scores was observed only at 2\u2009hours and 6\u2009hours in the ketamine group compared with placebo group (p&lt;0.05). Maternal adverse effects and neonatal outcomes were comparable between the two groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Intravenous administration of low dose ketamine before surgical incision significantly reduced the opioid requirement in the first 24 hours in patients undergoing non-elective caesarean delivery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial post-results\" xlink:href=\"NCT03450499\">NCT03450499<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044168","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T12:26:33Z","timestamp":1625055993000},"page":"e044168","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Analgesic effects of intravenous ketamine after spinal anaesthesia for non-elective caesarean delivery: a randomised controlled trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct03450499","registry":"10.18810\/clinical-trials-gov","type":"postResults"}],"author":[{"given":"Prahlad","family":"Adhikari","sequence":"first","affiliation":[{"name":"Anesthesiology, Narayani Sub-regional Hospital, Birgunj, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0471-8760","authenticated-orcid":false,"given":"Asish","family":"Subedi","sequence":"additional","affiliation":[{"name":"Anesthesiology & Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birendra Prasad","family":"Sah","sequence":"additional","affiliation":[{"name":"Anesthesiology & Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Pokharel","sequence":"additional","affiliation":[{"name":"Anesthesiology & Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"2025101813145895000_11.6.e044168.1","first-page":"1341","article-title":"A hospital-sponsored quality improvement study of pain management after cesarean delivery","volume":"190","author":"Yost","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"2025101813145895000_11.6.e044168.2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.4103\/ija.IJA_313_16","article-title":"Post-caesarean analgesia: what is new?","volume":"61","author":"Kerai","year":"2017","journal-title":"Indian J Anaesth"},{"key":"2025101813145895000_11.6.e044168.3","article-title":"Perioperative ketamine for acute postoperative pain","volume":"1","author":"Bell","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101813145895000_11.6.e044168.4","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(91)90100-C"},{"key":"2025101813145895000_11.6.e044168.5","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199501000-00026"},{"key":"2025101813145895000_11.6.e044168.6","first-page":"CD012033","article-title":"Perioperative intravenous ketamine for acute postoperative pain in adults","volume":"12","author":"Brinck","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101813145895000_11.6.e044168.7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijoa.2010.10.002","article-title":"Low-dose ketamine with multimodal postcesarean delivery analgesia: a randomized controlled trial","volume":"20","author":"Bauchat","year":"2011","journal-title":"Int J Obstet Anesth"},{"key":"2025101813145895000_11.6.e044168.8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ijoa.2012.04.004","article-title":"Low-dose intravenous ketamine improves postoperative analgesia after caesarean delivery with spinal bupivacaine in African parturients","volume":"21","author":"Menkiti","year":"2012","journal-title":"Int J Obstet Anesth"},{"key":"2025101813145895000_11.6.e044168.9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ogrm.2008.03.005","article-title":"Classification of urgency of caesarean section","volume":"18","author":"Yentis","year":"2008","journal-title":"Obstet Gynaecol Reprod Med"},{"key":"2025101813145895000_11.6.e044168.10","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2015.00991","article-title":"Hallucinations and related concepts-their conceptual background","volume":"6","author":"Telles-Correia","year":"2015","journal-title":"Front Psychol"},{"key":"2025101813145895000_11.6.e044168.11","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/82.6.881"},{"key":"2025101813145895000_11.6.e044168.12","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200111000-00052"},{"key":"2025101813145895000_11.6.e044168.13","doi-asserted-by":"crossref","first-page":"230","DOI":"10.5812\/aapm.7034","article-title":"Analgesic effects of intravenous ketamine during spinal anesthesia in pregnant women undergone caesarean section; a randomized clinical trial","volume":"3","author":"Behdad","year":"2013","journal-title":"Anesth Pain Med"},{"key":"2025101813145895000_11.6.e044168.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2007.00160.x"},{"key":"2025101813145895000_11.6.e044168.15","doi-asserted-by":"crossref","first-page":"218","DOI":"10.12968\/bjom.2005.13.4.17981","article-title":"Psychological trauma symptoms of operative birth","volume":"13","author":"Gamble","year":"2005","journal-title":"Br J Midwifery"},{"key":"2025101813145895000_11.6.e044168.16","first-page":"25","article-title":"A comparative study to assess preoperative anxiety in obstetric patients undergoing elective or emergency cesarean section","volume":"21","author":"Bansal","year":"2017","journal-title":"Anaesth Pain Intensive Care"},{"key":"2025101813145895000_11.6.e044168.17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijoa.2019.05.009","article-title":"Post-caesarean delivery analgesia in resource-limited settings: a narrative review","volume":"40","author":"Bishop","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"2025101813145895000_11.6.e044168.18","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ijoa.2019.06.009","article-title":"Systemic adjunct analgesics for cesarean delivery: a narrative review","volume":"40","author":"Hamburger","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"2025101813145895000_11.6.e044168.19","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/aas.12468","article-title":"Intravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis","volume":"59","author":"Heesen","year":"2015","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025101813145895000_11.6.e044168.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(99)00044-5"},{"key":"2025101813145895000_11.6.e044168.21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/BF03014321","article-title":"Pre-emptive analgesia with ketamine, morphine and epidural lidocaine prior to total knee replacement","volume":"44","author":"Wong","year":"1997","journal-title":"Can J Anaesth"},{"key":"2025101813145895000_11.6.e044168.22","doi-asserted-by":"publisher","DOI":"10.1111\/cns.12099"},{"key":"2025101813145895000_11.6.e044168.23","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1213\/00000539-198202000-00004","article-title":"Plasma levels of ketamine and two of its metabolites in surgical patients using a gas chromatographic mass fragmentographic assay","volume":"61","author":"Domino","year":"1982","journal-title":"Anesth Analg"},{"key":"2025101813145895000_11.6.e044168.24","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet192"},{"key":"2025101813145895000_11.6.e044168.25","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/00004714-198504000-00003","article-title":"Ketamine: behavioral effects of subanesthetic doses","volume":"5","author":"Ghoneim","year":"1985","journal-title":"J Clin Psychopharmacol"},{"key":"2025101813145895000_11.6.e044168.26","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(88)90095-9"},{"key":"2025101813145895000_11.6.e044168.27","first-page":"774","article-title":"A study of low-dose S-ketamine infusion as \"preventive\" pain treatment for cesarean section with spinal anesthesia: benefits and side effects","volume":"78","author":"Suppa","year":"2012","journal-title":"Minerva Anestesiol"},{"key":"2025101813145895000_11.6.e044168.28","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.egja.2012.02.001","article-title":"Effect of ketamine on intraoperative nausea and vomiting during elective caesarean section under spinal anaesthesia: a placebo-controlled prospective randomized double blinded study","volume":"28","author":"Shabana","year":"2012","journal-title":"Egypt J Anaesth"},{"key":"2025101813145895000_11.6.e044168.29","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.23736\/S0375-9393.18.12478-3","article-title":"Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review","volume":"84","author":"Liu","year":"2018","journal-title":"Minerva Anestesiol"},{"key":"2025101813145895000_11.6.e044168.30","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1399-6576.1977.tb01191.x","article-title":"Transplacental passage of ketamine after intravenous administration","volume":"21","author":"Ellingson","year":"1977","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025101813145895000_11.6.e044168.31","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318242b2cd"},{"key":"2025101813145895000_11.6.e044168.32","doi-asserted-by":"publisher","DOI":"10.1258\/la.2011.010179"},{"key":"2025101813145895000_11.6.e044168.33","first-page":"185","article-title":"Does anesthetic induction for cesarean section with a combination of ketamine and thiopentone confer any benefits over thiopentone or ketamine alone? A prospective randomized study","volume":"75","author":"Nayar","year":"2009","journal-title":"Minerva Anestesiol"},{"key":"2025101813145895000_11.6.e044168.34","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1213\/00000539-197801000-00026","article-title":"Arterial blood gases in mothers and infants during ketamine anesthesia for vaginal delivery","volume":"57","author":"Maduska","year":"1978","journal-title":"Anesth Analg"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-044168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:15:04Z","timestamp":1760818504000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-044168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,30]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bmjopen-2020-044168"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-044168","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}