Intravenous and Peritonsillar Infiltration of Ketamine for Postoperative Pain after Adenotonsillectomy: A Randomized Placebo-Controlled Clinical Trial

Abstract

Objective: To evaluate the efficacy of preoperative intravenous or peritonsillar infiltration of ketamine for postoperative pain control in children following adenotonsillectomy. Patients and Methods: 78 children between 5 and 18 years of age who were scheduled for elective adenotonsillectomy were randomly assigned to four groups: group 1 (n = 19) received intravenous ketamine (0.5 mg/kg), group 2 (n = 21) intravenous normal saline, group 3 (n = 19) ketamine (0.5 mg/kg) injected through the tonsillar capsule, and group 4 (n = 19) normal saline injected in the same location. The incidence of postoperative pain and vomiting as well as the severity of postoperative pain were compared between study groups during the 6-hour postoperative period using a visual analog scale (VAS) at rest, upon swallowing saliva, drinking liquids and eating ice cream. Results: There were no demographic differences between the four groups. The incidence of postoperative pain was significantly lower in groups 1 [7 (36.8%) vs. 10 (47.6%); p = 0.032] and 3 [5 (31.5%) vs. 12 (63.2%); p = 0.001] compared with their controls. The amount (in milligrams) of pethidine and metoclopramide used for pain and nausea control was significantly lower in groups 1 (12.5 ± 5.3 vs. 19.6 ± 9.6 mg, p = 0.038, and 2.9 ± 1.1 vs. 4.6 ± 2.6 mg, p = 0.042, respectively) and 3 (8.6 ± 3.1 vs. 21.6 ± 8.4 mg, p < 0.001, and 1.6 ± 0.9 vs. 5.3 ± 3.2 mg, p = 0.002, respectively) compared with their controls. These values were also higher in group 1 compared with group 3. The VAS scores on swallowing saliva (3.9 ± 2.7 vs. 2.7 ± 1.2; p = 0.018), on drinking liquids (3.7 ± 2.6 vs. 2.8 ± 1.6; p = 0.013) and on eating ice-cream (4.3 ± 2.4 vs. 2.8 ± 1.5; p = 0.001) were also significantly higher in group 1 compared with group 3. Conclusions: Our results show that peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity, need for analgesics and need for antiemetics. Thus, peritonsillar infiltration of ketamine is suggested for postoperative pain control in those undergoing adenotonsillectomy.

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

“…Preoperative ketamine administration through the intravenous and peritonsillar infiltration both reduce the incidence and severity of postoperative pain as well as the need for analgesics in children undergoing tonsillectomy. However, peritonsillar infiltration was more effective in reducing the pain severity and need for analgesics [13]. In particular, despite being statistically insignificant, peritonsillar infiltration of ketamine showed a large effect size (>0.8) during the late postoperative period (6–24 hours).…”

“…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 ...…”

Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study

“…13,17,20 Recently, Imai et al 13 performed a retrospective review of the medical records of 653 patients with endometrial cancer. They classified the patients based on the KCC score and found that there was no difference in survival between patients with KCC score 0 who were or were not treated with lymphadenectomy.…”

Adição de 75mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea

“…4 Os opiáceos desempenham um papel importante no tratamento da dor no período pós-operatório, a despeito de efeitos colaterais importantes 5 que podem afetar de modo significativo a recuperação do paciente após a cirurgia. 6 Assim, o manejo multimodal da dor no pós-operatório também pode ser útil para reduzir os efeitos secundários relacionados aos opiáceos. 7 A adição de novos medicamentos adjuvantes como os gabapentinoides a um regime analgésico multimodal, que mostrou ser eficaz na analgesia pós-operatória em diferentes procedimentos, pode ser razoável para diminuir os escores de dor no pós-operatório, o consumo total de opiáceos e os efeitos colaterais após nefrolitotomia percutânea.…”