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

Abstract

Background and objectivesThe goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.Subjects and MethodsTwo authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0–24 hours after leaving the operation room were included in the analysis.ResultsThe pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.ConclusionPreoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.

Differences between adolescents and adults in the acute effects of PCP and ketamine and in sensitization following intermittent administration

“…When awakening from ketamine anesthesia, adult patients often experience an emergence reaction characterized by bad dreams and psychotomimetic effects, while this is less prominent in children or adolescents (Cho et al, 2014; Green et al, 2009; Green et al, 2011). Similarly, while adult laboratory rats show neurotoxic effects of high doses of dissociatives, this is not seen in young adolescent animals (Farber et al, 1995; Farber and Olney, 2003; Noguchi et al, 2005; Olney and Farber, 1995).…”

“…Ketamine is better tolerated in children than adults. Children exhibit decreased psychotomimetic effects that are characterized by bad dreams and hallucinations (Cho et al, 2014; Green et al, 2009; Green et al, 2011). Aside from applications in pain relief, ketamine is also a fast-acting antidepressant that has been used with notable success in cases where traditional antidepressants are not effective.…”

Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: A prospective, double-blind, controlled clinical study

“…The healing of tonsillar fossa takes about 2 weeks and, although gradually decreasing over the first week, significant to moderate pain resides during that period (4). Post-tonsillectomy pain may lead to poor oral intake, dehydration, late hemorrhage, emesis, sleep disturbances and behavioral differences and, therefore, usually requires careful management by oral analgesics (2,(5)(6)(7)10,11,24,25). The mostly prescribed opioids for post-tonsillectomy pain relief are acetaminophen with codeine and oxycodon or hydrocodone (4,5).…”

“…Opioid related respiratory depression was reported to be one of the main reasons of post-tonsillectomy mortality especially in young children (2,10,25). Both the Food and Drug Administration (FDA) and The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) declared a safety warning for the use of codeine in treatment of pain following tonsillectomy (2,3,5,11).…”

“…It was well reported that respiratory depression, sedation and bleeding resulted from the unpredictable metabolism of opioids were one of the reasons of morphine toxicity causing morbidity and life-threading post-tonsillectomy complications (2,5,10). Therefore, the use of safer opioid and non-opioid analgesics as an alternative approach to relieve the pain caused by tonsillectomy is getting more important.…”