Indrati

Indrati Tyas
Tyas Siwi
Siwi TR,
TR, Doso
Doso Sutiyono,
Sutiyono, Taufik
Taufik Eko
Eko Nugroho
Nugroho

KETAMINE ADJUVANT FOR SINGLE SHOT

THORACIC PARAVERTEBRAL BLOCK ON
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MODIFIED RADICAL MASTECTOMY

BACKGROUND
Single shot thoracic paravertebral block (STPVB) is
most commonly used to provide anesthesia and
analgesia.
STPVB is more comfortable and easier to applied
than the multiple shot TPVB.
Ketamine has local-anesthetic-like effects and has
been extensively used through epidural and caudal
routest
The effect of ketamine as adjuvant in STPVB will be
examined in this case.

OBJECTIVE

To evaluate the effectiveness of ketamine adjuvant in

STPVB for managing post operative pain after MRM.

METHODS
Six womans age 35-60 years old were scheduled for elective
MRM.
Premedication using midazolam 0.07 mg/kg.
They were randomized into 2 groups: (1) using injection
Bupivacaine 0.5 % + 0.1 mg epinephrine, with total volume 21 cc
(2) bupivacain 0.5% + 0.1 mg epinephrine + ketamine 0.5mg/kg
with total volume 21cc.
Induction using propofol 2 mg/kg, rocuroneum 0.7 mg/kg.
Maintenance with O2 and sevoflurane.
We evaluate post operative pain using VAS scale and
hemodynamic status of patients.
Ketorolac 30 mg intravenous administration started when Visual
Analogue Scale > 4.

RESULTS

Patient with STPVB (1) have been managed post

operative analgetic for 18, 20, and 22 hours.
In patient with ketamine adjuvant (2) the analgetic effect
have been prolonged for 36, 37, and 40 hours.
Post operative hemodynamic status was stable.

Group 1

Group 2

VAS
1

mean

mean

12

12

12

12

12

12

12

12

18

18

17

15

18

18

17

24

30

30

28

18

20

22

20

36

37

40

38
Diagram score VAS and duration
40
35
30
25
Group 1
Column1

Hours 20
15
10
5
0

VAS 1

VAS 2

VAS 3

score VAS

VAS 4

CONCLUSION

Ketamine as adjuvant on STPVB was improve acute

post operative pain management by increase the duration
of paravertebral block.

DISCUSSION
Ketamine act on the central nervous system and work as
a noncompetitive antagonist of the N-methyl-D aspartate
receptor (NMDAR)
The NMDAR is an excitatory glutamatergic receptor in
the spinal and supraspinal sites involved in the afferent
transmission of nociceptive signals
Ketamine will spread in paravertebral space and enter to
prevertebral plane, epidural, intercostal space and absorb
in systemic circulation on STPVB

Thank You !

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