Comparative Study of Hemodynamic Changes of Intrathecal Bupivacaine with or without Ketamine for Lower Limb Surgeries

Introduction: Spinal anaesthesia is well accepted anaesthetic procedure for lower limb surgeries. Though spinal anaesthesia has many advantages, it has some major complications like hypotension and bradycardia. This prospective double blind study was carried out to see whether the sympathomimetic effect of intrathecal ketamine attenuates bupivacaine induced hypotension and bradycardia. Methods: Sixty patients of American Society of Anaesthesiologist (ASA) physical status I and II undergoing lower limb surgeries were randomly allocated into two groups. Group Bupivacaine (B) patients received intrathecal Bupivacaine 0.5% heavy and Group Bupivacaine+Ketamine (BK) received bupivacaine along with Ketamine. Hemodynamics was monitored. Results: Heart rate fluctuation in group B was ± 10% and in group BK was ± 14% from the baseline. Mean arterial pressure fluctuation in group B was ±10 % and in group BK was ±8% from the baseline. 24.13% of patients in group B and 18.5% patients in group BK had hypotension. 17.24% patients in group B and 3.70% patients in group BK had bradycardia. More fluids were required to maintain intraoperative hemodynamics in group B Conclusion: We conclude that intrathecal addition of ketamine with bupivacaine gives better hemodynamic stability and minimize requirement of vasopressors and intraoperative fluid.