A Comparative Evaluation of the Anaesthetic Properties of Bupivacaine Hydrochloride and Ketamine Hydrochloride with Dextrose Given Intrathecally for Inguinal Hernia Repair - A Prospective Observational Study in a Tertiary Care Centre, South Kerala


Ranju Sebastian1, Remani Kelan Kamalakshi2, Jamsheena Muthira Parambath3, Praseetha Vallomparambath Kuttiparambil4

Spinal Anaesthesia is the most commonly used form of anaesthesia for surgeries
below the level of umbilicus. Bupivacaine is the drug of choice for subarachnoid
block. Spinal anaesthesia with bupivacaine is associated with many side effects
and complications especially in patients with multiple co-morbid conditions. In our
study we compared the anaesthetic effectiveness of 3.5 ml hyperbaric bupivacaine
with a mixture of 100 mg ketamine and 0.1 mg adrenaline, the solution is made
hyperbaric by adding 1.4 ml of 5 % dextrose given intrathecally. The objective of
our study was to compare the anaesthetic properties and clinical effectiveness of
intrathecally administered ketamine with bupivacaine for inguinal hernia repair.
This prospective observational study was conducted on fifty American society of
Anaesthesiologists (ASA) 1 and 2 patients in the age group of 25 – 60 years posted
for elective inguinal hernia repair from December 2004 to December 2005. They
were allocated in to two groups. Group 1 (Bupivacine group) and Group 2
(Ketamine group). Bupivacaine group (group 1) received 3.5 ml of bupivacaine
heavy and ketamine group (group 2) received preservative free ketamine 100 mg
with 0.1 mg adrenalin 1/1000 solution in 1.4 ml of 5 % dextrose to make it heavy.
Anaesthetic properties, side effects and complications of both groups were
compared intraoperatively.
The onset of action of ketamine (1.58 minutes) was faster than bupivacaine (3.31
minutes) which is statistically significant. Duration of blockade was longer in
bupivacaine group (sensory 227.92 and motor 203.08) compared to ketamine
group (sensory 143.40 and motor 109.46). Ketamine group showed a greater level
of haemodynamic stability than bupivacaine group.
Intrathecal ketamine produces optimal anaesthetic conditions for surgeries like
inguinal hernia repair. Haemodynamic stability provided by intrathecal ketamine is
beneficial in patients with multiple comorbidities.