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Patient anxiety scores after low-dose ketamine or fentanyl for epidural catheter placement

From the Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu City, Gifu 500-8705, Japan.

Address correspondence to: Shuji Dohi MD. Phone: +81-58-267-2295; Fax: +81-58-267-2961; E-mail: shu-dohi{at}cc.gifu-u.ac.jp

Purpose: To compare the effect of low-dose ketamine with that of low-dose fentanyl on patient anxiety during the identification of the epidural space and catheterization.

Methods: Sixty patients were randomly assigned to one of three groups: saline group (n=20), saline 2 ml; ketamine group (n=20), 5 mg ketamine; or fentanyl group (n=20), 50 µg fentanyl. Each drug was administered intravenously (iv) five to ten minutes before the epidural procedures began. After epidural catheter placement had been accomplished, anxiety and pain were rated using a visual analog scale.

Results: The anxiety scores given for ketamine(20.2 ± 18.5, mean ± SD) and fentanyl (24.6 ± 20.3) were similar, and both were lower than that for saline (44.1 ± 32.7) (P=0.0034 and 0.0153 vs saline group, respectively). Pain scores were similar for all three groups. A decrease in hemoglobin oxygen saturation during the procedure was only observed in the fentanyl group, and two patients in fentanyl group had SpO₂ <90%.

Conclusion: Ketamine, 5 mg iv, is as effective as 50 µg fentanyl, iv, in alleviating patient anxiety and in providing adequate sedation during the procedures necessary for epidural catheter placement, without inducing severe complications.