Comparison of the Effects of Adding of Ketamine to Pre- Incisional Bupivacaine Injection on Postoperative Pain Relief after Tonsillectomy in Children

Pain control in children is still a therapeutic dilemma and preschool patients are affected from undesirable effects of postoperative pain more than adults. The aim of this work was to compare the effects of adding of Ketamine to pre-incisional Bupivacaine injection of post-operative pain relief after tonsillectomy. Sixty-three children that classified as ASA class I and II scheduled for adenotonsillectomy and divided into three groups (every group had 21 patients). Group 1: Bupivacaine (0.5%) 2mg/kg, Group 2: Ketamine 0.5 mg/kg and Group 3: Ketamine 0.5mg/kg and Bupivacaine (0.5%) 2mg/kg was injected into tonsillar bed by the surgeon. Side effects were evaluated at 1, 4 and 24 hours after adenotonsillectomy. The correlation between the data was done by Chi-square test and a P<0.05 was considered significant. One hour after surgery, in group 3, pain score was lower than other groups (P>0.05). Besides, after 4 hours in group 3, there was no severe pain in patients and higher percent of patients (61.9%) had mild pain compared to group 2 (P>0.05) and group 1 (P<0.05). After 24 hours, higher percent of patients without pain were in group 3 compared to group 2 (P>0.05) and group 1 (P=0. 05). In conclusion, adding of Ketamine to pre-incisional Bupivacaine injection resulted in post-operative acceptable pain relief with lower side effects after adenotonsillectomy.