224 J Contemp Med Sci | Vol. 4, No. 4, July-August 2019: 224–226 Comparison of the effect of dexmedmotidine and ketamine on controlling pain after cesarean section via intra-peritoneal method Alireza Kamali,1 Maryam Maktabi,2 Zoha Khademi,1 and Taha Fereidooni1 1Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran. 2Department of Gynecology, Arak University of Medical Sciences, Arak, Iran. Correspondence to Maryam Maktabi (email: dralirezakamalianesthesiology@gmail.com). (Submitted: 26 April 2019 – Revised version received: 12 May 2019 – Accepted: 23 June 2019 – Published online: 26 August 2019) Objective The present study aimed to compare the effect of dexmedmotidine and ketamine on controlling pain after cesarean section via intra-peritoneal method. Methods In this clinical and double-blind clinical trial, patients were randomly divided into two groups (dexmedmotidine and ketamine). In the first group, 5 mg/kg ketamine and 1 mg/kg dexmedetomidine were injected in 100 mg normal saline. Pain score was measured on the basis of the visual analog pain scale during the recovery at 4, 6 and 12 h after the surgery. The data were then analyzed by SPSS (version 20). Results A total of 70 patients participated in the study. The results showed that the mean pain scores were the same in different postoperative hours in patients (P ≥ 0.05). The mean opioid use in the ketamine group was lower than inter-peritoneal dexmedmotidine (P = 0.03). Moreover, the mean postoperative analgesia in the ketamine group was higher than inter-peritoneal dexmedmotidine (P = 0.04). Conclusion According to the results, the mean opioid consumed in the ketamine group was less than inter-peritoneal dexmedmotidine. Additionally, the mean postoperative analgesia in the ketamine group was higher than that of inter-peritoneal dimethomidine. Therefore, it can be concluded that ketamine has a better effect on reducing pain after cesarean section. Keywords intra-peritoneal, dexmedmotidine, cesarean section, ketamine, pain control Introduction Pain is a completely mental experience, which produces adverse hemodynamic and metabolic responses in patients.1,2 Millions of people around the world undergo surgery and then experience post-surgical pain. Postoperative pain leads to harmful effects, such as atleticas, thrombosis, ischemic myo- cardium, cardiac arrhythmias, water and electrolyte disorders, urinary retention and ileus.3,4 One of the most commonly used surgical procedures is cesarean section. Caesarean section is used in cases where delivery is impossible or if there is a risk to the mother and the baby. This procedure has played an impor- tant role in reducing maternal and fetal deaths and complica- tions over the last century.5,6 Cesarean section is performed in two ways, including general anesthesia or regional anesthesia.7 One of the problems of cesarean section is acute postoperative pain that causes unpleasant psychological responses such as anxiety, sadness, aggression, insomnia, and lack of logical con- nection with the physician and nurse. It may also reduce breastfeeding and mother’s tolerance for breastfeeding.8,9 One of the most important issues in cesarean section is to reduce postoperative pain. By reducing the pain, mothers will be able to perform their motherhood duties well, leading to earlier and more appropriate lactation. Opioid drugs such as mor- phine and pethidine, which are the most commonly used drugs to relieve postoperative pain, are associated with unpleasant complications such as addiction, respiratory arrest, resistance, nausea, vomiting, etc. Therefore, the use of alterna- tive opioid drugs to prevent postoperative pain has always been pursued by surgeons and researchers.10 Genealogy is one of the widely used methods that reduces the effect of opioid drugs on the fetus.11 First identified in 1951 by Griffin, intra-perotone anesthesia is a new method for reducing post- operative pain. Various studies have focused on pain relief after laparoscopy, hysterectomy, and laparoscopic surgery via intra-peritoneal method. The systemic effect of this method begins two minutes after the intraperitoneal injection.12 Var- ious adjuvants can be used, including dexmedmotidine and ketamine. Ketamine is an NMDA receptor antagonist and an anesthetic drug.13 Ketamine is also an intravenous anesthetic with an analgesic effect which stimulates the cardiovascular system with minimum respiratory suppression.14 Dexmed- motidine is analgesic, sedative, and antihypertensive.15 Dex- medmotidine and ketamine alone increase the duration of analgesia and reduce the use of narcotics. On the other hand, the intra-peritoneal method during childbirth has a significant effect on the health of the fetus because it reduces the likeli- hood of anesthetic drug transfer from mother to fetus. Given that all studies conducted on abdominal surgery have only investigated the effect of a single drug, we aimed to compare the effect of dexmedmotidine and ketamine on controlling pain after cesarean section via intra-peritoneal method. Materials and Methods This double-blind clinical trial was carried out on all patients who underwent cesarean section. All candidates for cesarean section referred to Taleghani Hospital in Arak, Iran. The can- didates for cesarean section who entered the study were ran- domly divided into two groups (dexmedmotidine and ketamine). Inclusion Criteria 1. Aged 18–35 years. 2. ASA (American Society of Anesthesiologists). 3. Female candidates for cesarean section. ISSN 2413-0516 Original A. Kamali et al. 225J Contemp Med Sci | Vol. 4, No. 4, July-August 2019: 224–226 Comparison of the effect of dexmedmotidine and ketamine Exclusion Criteria 1. Having a history of allergy to dexmedmotidine and ketamine. 2. Having heart and respiratory disease. 3. Emergency cesarean section. At first, all patients provided informed consent. Then, 5 mg/kg ketamine and 1 mg/kg dexmedmotidine were injected in the ketamine and dexmedmotidine group, respectively. In both groups, the normal saline solution mixed with drugs was injected into the patient’s peritoneum. The pain was measured according to the Visual Analog Scale (VAS) at 4, 6 and 12 h after the operation. In this scale, zero expresses the lowest value and the 10 represents the highest value. It should be noted that the data were measured and recorded by a gynecol- ogist who was unaware of the groupings. The drugs in each group were prepared by an anesthetist. The sample size and number were calculated as follows: N Z Z = + æ è çç ö ø ÷÷ + + = - - 1 2 1 2 2 2 70 a b d d m m ( ) ( ) 1 2 1 2 Patients were divided into two groups (n = 35). Data analysis The data were analyzed using SPSS (version 20), while descrip- tive statistics and t-test were used to analyze parametric and nonparametric data. Ethical considerations 1. Obtaining a letter of introduction from the university’s authorities to be introduced to the research centers. 2. Obtaining a letter of introduction from the authorities of the researcher centers. 3. The purpose of the study was described for all research units and written consent was obtained from them. Results A total of 70 patients were included in the study, who were classified into two groups. They were evaluated in terms of mean age. According to the results, the mean age in the dex- medmotidine group and ketamine group was 34.4 ± 3.1 and 35.1 ± 4.7 years, respectively (P = 0.6). There was no significant difference between the two groups in terms of mean age. It can be said that the mean age of patients was similar in the two groups. Table 1 shows the comparison of pain scores between the two groups. Given the fact that P < 0.05, there was no signifi- cant difference between the groups in scores of pain 4, 6, and 12 h after the recovery. The mean pain score was almost sim- ilar in patients at different hours after the surgery. According to Table 2, there was a significant difference between the two groups in terms of drug abuse in 12 h after the surgery (P = 0.03), indicating that the mean drug in the ketamine group was lower than that of dexmedmotidine. In Table 3, the mean duration of analgesia was evaluated and P = 0.04 was significant in two both. This indicates that the Table 1 Comparison of pain scores Group Dexmedmotidine Ketamine P Pain Mean ± SD Mean ± SD VAS 0.0 ± 0.0 0.0 ± 0.0 ≥0.05 VAS 4 h after the surgery 1.1 ± 0.65 0.98 ± 0.23 0.2 VAS 6 h after the surgery 1.6 ± 3.4 1.7 ± 3.1 0.4 VAS 12 h after the surgery 1.1 ± 3.7 0.98 ± 3.8 0.6 Table 2. Comparison of drug abuse 12 h after the surgery Group Dexmedmotidine Ketamine P Variable Mean ± SD Mean ± SD Drug use 12 h after the surgery (mg) 35 ± 4.4 20.4 ± 3 0.03 Table 3. Comparison of the mean postoperative analgesia Group Dexmedmotidine Ketamine P Variable Mean ± SD Mean ± SD Postoperative mean pain (h) 12.6 ± 2.8 5.1 ± 13.3 0.04 duration of analgesia in the ketamine group was greater than that of dexmedmotidine. Discussion Cesarean section refers to the removal of the embryo from the abdominal wall and the uterus. This is done to ensure the health of the mother and the baby. 16 Cesarean section is char- acterized by acute post-operative pain. Effective management of post-operative pain is part of the surgical process and involves a multifaceted approach in which different drugs are used with different mechanisms and prescriptions. The admin- istration of non-opioid analgesics is an essential component of multi-faceted pain management programs.17 Therefore, the present study aimed to investigate the effect of dexmedmoti- dine and ketamine, using intra-peritoneal method, in order to control postoperative pain in patients who underwent cesarean section. In this study, there was no significant difference between the two groups in terms of the pain scores at different hours after surgery (P ≥ 0.05). Furthermore, the mean pain scores were similar in patients at different hours after sur- gery. In this study, there was a significant difference between the two groups in terms of drug abuse 12 h after the surgery (P = 0.03). Moreover, the mean opioid use in the ketamine group was lower than that of dexmedmotidine. Similarly, Shariat Moharari et al. investigated the effect of ketamine and bupiv- acaine on analgesia after laparoscopic cholecystectomy. Sha- riat Moharari et al. found that the duration of extubation in the ketamine group was higher. Moreover, pain was signifi- cantly lower in the ketamine group 6 h after surgery. The total amount of meperidine consumed within the 24-h period was lower in the ketamine group. In addition, the drug demand decreased. There was an increase in the duration of extuba- tion.18 In this study, there was a significant difference between the two groups (dexmedmotidine and ketamine) in terms of mean postoperative anesthesia. Moreover, the mean postoperative Original 226 J Contemp Med Sci | Vol. 4, No. 4, July-August 2019: 224–226 Comparison of the effect of dexmedmotidine and ketamine A. Kamali et al. analgesia in the ketamine group was significantly higher than that of dexmedmotidine (P = 0.04). Oza et al. aimed at com- paring the effects of intraperitoneal anesthesia of bupivacaine and dexmedmotidine only after laparoscopic surgery. Oza et al. investigated the duration of analgesia in the dexmedmoti- dine group. They found that the rate of intake of analgesics in the dexmedmotidine and bupivacaine was 1.76 and 2.56, respectively. This difference was significant (P ˂ 0.05). The mean analgesia was lower in the 24-h period in the dexmed- motidine group (P-value of −0.05). There was a significant dif- ference the two groups in terms of pain up to 12 h after the surgery, and the pain was lower in the dexmedmotidine group (P < 0.05). Bupivacaine and dexmedmotidine increased the duration of analgesia. They also reduced the number of appli- cations for postoperative analgesia.19 Chiruvella et al. used dexmedmotidine and rupivacaine to manage the postopera- tive pain after hysterectomy. The pain was lower in the rupiv- acaine and dexmedmotidine groups. The duration of analgesia was higher in this group. They stated that interferon dexme- dotomidine can reduce pain and drug use.20 Their results are not consistent with those of our study. In our study, the mean duration of analgesia was lower in the intraperitoneal keta- mine group. In our study, ketamine and dexmedmotidine were given intraperitoneally. Conclusion According to the results, the mean opioid use in the ketamine group was lower than that of dexmedmotidine. Moreover, the mean postoperative analgesia in the ketamine group was higher than that of dexmedmotidine. Therefore, it can be concluded that ketamine has a better effect on pain relief after cesarean section. Conflicts of Interest None.  This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly. References 1 Shang AB, Gan TJ. 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