Discussion
drowsiness, nystagmus, pain, dizziness, traumatic limb injuries, dry mouth, adverse drug reactions, Frey
NYSTAGMUS, DRY MOUTH, ADVERSE DRUG REACTIONS, COMPLICATIONS, FREY
Postoperative analgesia after CS is challenging since we need not only to consider maternal comfort, but the anesthetic technique should also have no adverse drug reactions on the newborn. The results of the present study showed that intranasal administration of ketamine significantly reduced the pain intensity of patients after CS and the amount of morphine consumption in the postoperative period. Very limited studies have investigated the effect of intranasal ketamine for reducing the pain intensity after surgery, especially CS. Most studies that have been performed to evaluate the analgesic effect of intranasal ketamine have been performed in the emergency department. In a study by El-Halwagy et al., intranasal administration of ketamine at a dose of 0.5 mg/kg, compared with intramuscular pethidine, significantly reduced the pain intensity of patients after CS (In another study, it was shown that intranasal ketamine (1.5 mg/kg) and intranasal fentanyl were associated with a significant reduction in pain intensity after tonsillectomy in children. There was no statistically significant difference between the two groups in the postoperative period, although the incidence of sedative effects was higher in the intranasal ketamine group than in the other group (Another study in patients undergoing spinal surgery showed that intranasal administration of S-ketamine (6 mg) as well as intranasal midazolam, compared with morphine administration using a PCA pump, was significantly associated with lower postoperative pain intensity. In general, there was no statistically significant difference in the incidence of complications in the three groups, although the incidence of nystagmus in the S-ketamine group and dry mouth in patients receiving morphine were slightly higher than the other groups (In their study, Frey et al. showed that intranasal ketamine use significantly reduced the severity of pain in children with traumatic limb injuries referred to the emergency department compared to intranasal fentanyl (In a study conducted by Quinn et al. which aimed to determine and compare the effect of intramuscular ketamine and fentanyl on moderate and severe pain in children referred to the emergency department, the results showed that in terms of pain intensity in two groups, there was no statistically significant difference 20 minutes after drug administration. However, the incidence of side effects in the ketamine group was significantly higher than the fentanyl group (Intranasal ketamine has been shown to have 45% bioavailability, which is higher than other methods of prescribing this drug. The clinical effects of ketamine can probably be explained by the absorption of the drug through the nasal mucosa, which allows it to act on the brain without first-pass metabolism. In a study evaluating the efficacy and pharmacokinetics of ketamine, it was shown that within 2 minutes after intranasal administration, ketamine was measurable in the blood at concentrations much higher than its less active metabolite, norectamine (In previous studies, drowsiness and dizziness have been mentioned as common side effects, which are usually mild or moderate, as well as temporary and transient and disappeared within 7–10 minutes (