Anesthesia for MVA in Resource-Limited Setting: Comparative Study of Ketamine Narcosis versus Intrathecal Analgesia in the DRC

Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inadequacies which have stimulated the search for an alternative technique which can be effective, such as microdose intrathecal spinal analgesia that can be recommended in limited resources environment. Aim: This work aims to contribute to the improvement of anesthetic techniques for incomplete abortion by MVA. Methodology: We conducted a prospective comparative study, type single blind non-inferiority randomized trial with an analytical aim. The study counted 2 parts: 1) Descriptive observational component (KET): Ketamine narcosis. 2) Experimental component, single-blind non-inferiority randomized clinical trial (RAS) microdose intrathecal spinal analgesia. Three hundred and twenty expected cases per randomized arms. Excel Software 2022, SPSS, Open Epi, and XL-SAT were used for data encoding and analysis. Results: A total of 322 cases were retained and analyzed: 1) 161 cases per randomized arm, the majority age group was between 18 - 50 years in the 2 groups and there was no correlation between the two. Protocols with the sociodemographic characteristics studied, ASA class, type of intervention, history of MVA, variation in heart rate, temperature, appearance of hypotension, cost of the anesthetic procedure and admission to intensive care. 2) Effectiveness of the RAS protocol: Judged easier by anesthetists at 99.38% compared to 93.79% for KET with significant difference (p = 0.0104), allows them to be more mobile during the procedure at 98.76 % against 68.32% with significant difference (p < 0.0001) and the overall assessment was in favor of the RAS protocol at a rate of 32.92% against 5.58% for the anesthetists, 90.68% for the patients and 100% for gynecologists who find it excellent compared to the KET protocol with significant difference (p < 0.0001). 3) Weaknesses of the KET protocol: unconsciousness in all patients during the procedure and provides more tachypnea (17.39%) compared to the RAS protocol with difference p = 0.0008, moderate hemorrhages (55.28%), severe (9.94%) with p = 0.0006, higher material cost with p = 0.0018, occurrence of vomiting (10.56%), delay in waking up (22.36%), post-MVA pain (21.74%), and a slight change in the modified Aldrete score at the 30th min post-MVA (70.19%) compared to RAS (81.61%) p = 0.0002. 4) No patient died during the study period in both protocols. Conclusion: Intrathecal spinal analgesia