The Pre-emptive Analgesic Effect of Peritonsillar Infiltration of Ketamine for Postoperative Pain Relief in Children Following Tonsillectomy

Document Type : Research Paper


1 Assistant professor ofAnesthesia and Intensive Care,Isfahan University of Medical Sciences, Isfahan, Iran,

2 Assistant professor of Otolaryngology, Head and Neck Surgery , Isfahan University of Medical Sciences, Isfahan, Iran,

3 Anesthesiology, Isfahan Universityof Medical Sciences, Isfahan, Iran,


In several studies, theuse of ketamine for the preemptive analgesiain the management of postoperative pain is controversial. The purpose of our study was the clinical assessment of the efficacy of preincisional peritonsillar infiltration of two doses of ketamineon postoperative pain relief compared with preincisional peritonsillar infiltration of saline in children undergoing tonsillectomy.
Materials and Methods
A total of Seventy-five ASA (American Society Anesthesia) physical status I and II patients, aged 3 to 12 years, scheduled for tonsillectomy were enrolled in this randomized, double-blinded, placebo-controlled study.Patients were divided into three groups of 25 each and received a local peritonsillarinfiltration of 0.9% saline (Group A), ketamine 0.5 mg/kg (Group B), or ketamine 1 mg/kg (Group C). All medications were 2 ml in volume which applied 1 ml per tonsil 3 min prior to tonsillectomy. The Children's Hospital Eastern Ontario Pain Scale (CHEOPS)and Wilson sedation scale were used to evaluate pain levels and sedative condition,respectively.
Group A had significantly higher CHEOPS scores than group B and group C. Group B and group C had comparable scores, which were not statistically significant (p> 0.05). During 24 hours after surgery, sixteen patients in group A and no patients in groups B or C needed analgesics (p< 0.001).
0.5 or 1 mg/kg dose of ketamine, given at approximately 3 min before surgery by peritonsillar infiltration, provides efficient pain relief without side-effects in children undergoing tonsillectomy.


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