Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

Abstract

It is useful for the medical education fields and all who are interested in that.Background: Pain control in children is still a therapeutic dilemma. Preschool patients are affected from undesirable effects of postoperative pain more than adults. Tonsillectomy is associated with a high incidence of postoperative pain, not only complicating the recovery, but also delaying patients discharge. Objectives: Despite employing different surgical and anesthetic strategies in post-tonsillectomy pain relief, this is still a clinical problem. The study was designed to evaluate the efficacy of a low dose ketamine in post tonsillectomy pain relief. Patients and Methods: Our prospective randomized double blinded study enrolled 75 pediatric patients (3-10 years old) who were scheduled for a tonsillectomy procedure. Patients were randomly assigned to one of three groups receiving; intravenous (IV) ketamine 0.5mg/kg, subcutaneous (SC) ketamine 0.5 mg/kg and placebo at the end of the operation. Post-operative pain score was assessed using modified CHEOPS. Results: In our study we did not find any significant difference among the three groups regarding sex, age, and weight, duration of operation, hemodynamic stability, and nausea and vomiting. However, in ketamine groups, pain score and analgesic consumption were significantly lower (P < 0.00). The efficacy of the both ketamine groups was similar. Conclusions: The study demonstrated that the both subcutaneous and intravenous injections of ketamine, at the end of the operation, were safe and effective for post-tonsillectomy pain control. Ketamine reduced postoperative analgesic medications consumption without increasing the risk of complications.

Post Tonsillectomy Pain: Can Honey Reduce the Analgesic Requirements?

“…Many researches have been performed to investigate different analgesics’ effects on post tonsillectomy pain, especially together with acetaminophen. In many studies, relief of early postoperative pain, in first hours of operation, was investigated ( 25 , 26 ). On the other hand, many studies look into postoperative pain after recovery room; in a study held in Finland, it was shown that ketoprofen combined with paracetamol - codeine seems to provide sufficient analgesia during 10 days after surgery ( 27 ).…”

Ketamine use in current clinical practice

“…Moreover, ketamine is superior to bupivacaine in terms of requiring rescue analgesia, promoting a peaceful sleep pattern and the early resumption of feeding [69] . Javid and colleagues [70] demonstrated that both subcutaneous and intravenous injections of ketamine at the end of surgery were safe and effective for post-tonsillectomy pain control without increasing the risk of complications. Two separate studies found the topical application of tramadol and ketamine to be a safe, effective, and easy analgesic approach for decreasing post-tonsillectomy pain [71,72] .…”

Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta‐analysis

“…The opioid medications are widely used as the main strategy for perioperative pain control, however, associated with side effects like respiratory depression, leading to sedation X Min et al and respiratory depression, and postoperative nausea and vomiting. In response to this, Non-opioid analgesic strategies including non-steroidal anti-inflammatory drugs, local anesthetic infiltration, antibiotics nonvolatile induction and maintenance, alpha-2 agonists, homeopathic drugs, caudal block, and delay of the emergence period have been studied to evaluate the effect on decreasing these complications but the results are not reliably helpful (6)(7)(8)(9)(10)(11).…”