Comparison of Ketamine and Fentanyl for Postoperative Pain Relief in Children Following Adenotonsillectomy

Abstract

Adenotonsillectomy has a high incidence of postoperative pain. Therefore, the purpose of this study was to evaluate the effectiveness and safety of either ketamine or fentanyl for postoperative pain relief in children following adenotonsillectomy. Sixty children aged 3-12 years, scheduled for adenotonsillectomy, were enrolled in this randomized, double-blind study. Patients were divided into two groups of 30 cases and received intravenous ketamine (0.5 mg kg(-1)) or fentanyl (1 microg kg(-1)). Modified Hannallah pain scale or Observational Pain Scores (OPS), nausea, vomiting, bleeding, rescue analgesia, sedation and post-anesthesia recovery scores were recorded both at first and 15th minute postoperatively. Moreover, patients receiving ketamine (group 1) or fentanyl (group 2) had comparable OPS and sedation score both on arrival and at 15th minute in the recovery room (p > 0.05). Although rescue analgesics were similarly required in both groups (p > 0.05), the time to reach rescue analgesia was shorter in group 1 (p = 0.001). Only one patient in fentanyl group had nausea and vomiting in the first 15 min that needed antiemetic in the recovery room. In conclusion, intravenous fentanyl (1 microg kg(-1)) compared with intravenous ketamine (0.5 mg kg(-1)) might provide extended time to first analgesic in children undergoing adenotonsillectomy. Interestingly, fentanyl and ketamine did not differ in post-operative vomiting.

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

“…164 • Local wound infiltration by the surgeon of a long-acting local anesthetic. 60,139,[165][166][167][168][169] • Intravenous fentanyl or morphine or other suitable agent (if available) to treat breakthrough pain in the PACU 51,[170][171][172] • Oral NSAIDs and/or paracetamol in adequate dosage during the entire postoperative period from the moment when the oral intake will be possible. 173,174 • Intravenous or oral tramadol or other suitable agent if available as rescue in the ward.…”

Intraoperative Analgesia and Postoperative Recovery in Children Undergoing Tonsillectomy: a Comparison Between Fentanyl and Pethidine

“…In a study by Mukherjee et al 13 the efficacy of intravenous fentanyl and morphine for perioperative analgesia in children undergoing adenotonsillectomy were similar and had comparable pain scores and requirement of rescue analgesia in the postoperative period. They observed that postoperative vomiting was less with those received fentanyl.…”

Efficacy of Ketamine in Improving Pain after Tonsillectomy in Children: Meta-Analysis

“…Outcomes analyzed were postoperative pain (pain scores after leaving the operation room) [2]–[5], [8]–[23], postoperative (24 hours) analgesic requirements (either doses or percentage of patient receiving postoperative opioids or nonopioids analgesics)[2]–[4], [8]–[10], [12]–[14], [16], [19], [20], [22]–[25], time to first analgesic administration (opioid or nonopioid analgesics administered with a defined pain intensity target)[3]–[5], [8]–[10], [12]–[14], [18], [22], [23], [26], time to first oral uptake [2], [5], [13], [14], postoperative nausea and vomiting (percentage of patients or dose of antiemetics) [2], [8], [9], [12]–[18], [24], [25] and the occurrence of psycho-mimetic manifestations including nightmares [9], [10], [18], sleep pattern change (percentage of patients) [9], [10], [12], [19], hallucinations (percentage of patients) [5], [8], [18], [19], [25] or sedation (sedation scores) [4], [5], [8], [9], [11], [15], [17], [24]. These outcomes were compared with preoperative ketamine ...…”