Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial

Abstract

AimTo assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects.MethodsThe double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery.ResultsTramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting.ConclusionPreoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects.Registration No: IRCT201103255764N2

Effect of Topical Bupivacaine on Post-Tonsillectomy Pain Relief in Children Referred to Ahvaz Imam Khomeini Hospital in 2013

“…Dexamethasone and other steroids are associated with some adverse effects such as adrenal dysfunction (2).…”

The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia

“…[28–30] The rate of titration of the opioids dose, rather than target dose, is the major determinant of a patient's tolerability. [3132] In our study, patient satisfaction was significantly higher in groups P and T when compared with groups B and C [Table 4]. However, it should be remembered that the analgesic efficacy is likely dependent upon multiple variables.…”

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

“…Ketamine has been used to reduce post-operative pain following various surgical procedures like hernioraphy [20], abdominal hysterectomy [21], thoracotomy [22], circumcision [23], cesarean section [24], open cholecystectomy [25], appendectomy [26], tonsillectomy [27][28][29][30][31]. Recently ketamine has been used in oral and maxillofacial surgical practice as well [14,[32][33][34][35][36].…”

“…Many studies have evaluated the effectiveness of ketamine administered locally to the peri-tonsillar region following tonsillectomy for postoperative pain management [27][28][29][30][31]. Tan et al [23] gave a subcutaneous ring infiltration of ketamine at the incision site before circumcision surgery and showed that the time interval until first analgesic demand was longer and the incidence of pain-free status during movement and erection was significantly higher than for the saline-treated analogs.…”