Anesthesiology and Pain Medicine
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.
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.
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.
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.
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.
© 2012, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Kimiaei Asadi H, Nikooseresht M, Noori L, Behnoud F. The Effect of Administration of Ketamine and Paracetamol Versus Paracetamol Singly on Postoperative Pain, Nausea and Vomiting After Pediatric Adenotonsillectomy. Anesth Pain Med. 2016;6(1):e31210. doi: https://doi.org/10.5812/aapm.31210
Hosseini Jahromi SA, Hosseini Valami SM, Hatamian S. Comparison Between Effect of Lidocaine, Morphine and Ketamine Spray on Post-Tonsillectomy Pain in Children. Anesth Pain Med. 2012;2(1):17-21. doi: https://doi.org/10.5812/aapm.4092
Sanie MS, Kalani N, Ghobadifar MA, Zabetian H, Hosseini M. The Preventive Role of Low-Dose Intravenous Ketamine on Postoperative Shivering in Children: A Placebo Randomized Controlled Trial. Anesth Pain Med. 2016;6(3):e32172. doi: https://doi.org/10.5812/aapm.32172
Choubsaz M, Mohseni G, Jorair-Ahmadi S, Sadeghi M. Comparison of the Effects of Adding of Ketamine to Pre- Incisional Bupivacaine Injection on Postoperative Pain Relief after Tonsillectomy in Children. J Rep Pharm Sci. 2017;6(1):e147624. doi:
Javaherforooshzadeh F, Gousheh M, Akhondzadeh R, Olapour A, Derakhshandeh V, et al. Effect of Local Injection of Bupivacaine for Pain Management After Tonsillectomy: A Randomized Clinical Trial. J Compr Ped. 2021;12(3):e109328. doi: https://doi.org/10.5812/compreped.109328
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