Effect of Ketamine on Post-Tonsillectomy Sedation and Pain Relief

Document Type : Original

Authors

1 Cardiac Anesthesia Research Center, Imam-Reza Hospital, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

2 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Tonsillectomy is the one of the most common types of surgery in children, and is often accompanied by post-operative pain and discomfort. Methods of pain control such as use of non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, and local anesthetics have been used, but each have their own particular side effects. In this study we investigated the effect of ketamine on post-operative sedation and pain relief.
 
Materials and Methods:
A total of 50 children aged between 5 and 12 years who were candidates for tonsillectomy were divided into two groups. The study group received ketamine-midazolam (ketamine 1 mg/kg, midazolam 0.1 mg/kg) and the control group received midazolam (0.1 mg/kg) in the pre-operative period. The same methods of anesthesia induction and maintenance were used in all patients. Pain score was assessed using the Wong-Baker Faces Pain Rating scale and sedation was evaluated using the Riker Sedation-Agitation scale at the time of extubation as well as 5, 10, 15, and 30 minutes and 1, 2, and 6 hours after surgery.
 
Results:
The two groups were similar in terms of age, weight, gender and duration of surgery. Pain after 15 and 30 minutes and agitation after 10 and 15 minutes following extubation were lower in the study group (ketamine-midazolam). Mean consumption and time of first request for analgesia after surgery as well as incidence of post-operative vomiting were similar in the two groups.
 
Conclusion: 
Adding ketamine to midazolam in pre-operative of tonsillectomy reduces agitation and post-operative pain in the first 30 minutes after surgery.

Keywords

Main Subjects

References

1.  Leiberman A, Stiller-Timor L, Tarasiuk A, Tal A. The effect of adenotonsillectomy on children suffering from obstructive sleep apnea syndrome (OSAS). Int J Pediatr Otorhinolaryngol 2006; 70(10): 1675–82.
2. Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118(1):61–8.
3. Marret E, Flahault A, Samama CM, Bonnet F. Effects of postoperative, nonstrerioidal anti inflammatory drugs on bleeding risk after tonsille- ctomy: meta-analysis of randomized, controlled trials. Anesthesiology 2003; 98(6): 1497-502.
4. Umuroglu T, Eti Z, Ciftci H, Yilmaz Gogus F. Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol. Paediatr Anaesth 2004;14(7):568–73.
5. Bameshki AR, Razban M, Khadivi E, Razavi M, Bakhsaee M. The Effect of Local Injection of Epinephrine and Bupivacaine on Post-Tonsillectomy Pain and Bleeding. Iran J Otorhinolaryngol 2013; 25 (73):209–14.
6.  Bameshki AR, Mir Hosseini ME, Jahanbakhsh S, Soltani GH. Evaluation of Oral Ketamine for Postoperative Pain in Burn Patients. J Iran Anaesthesiol Intens Care 2005; 27(50):30–6.
7. Hong BH, Lee WY, Kim YH, Yoon SH, Lee WH. Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia. Korean J Anesthesiol 2011; 61(3):238–43.
8.  Erhan OL, Göksu H, Alpay C, Beştaş A. Ketamine in post-tonsillectomy pain. Int J Pediatr Otorhino- laryngol 2007; 71(5):735–9.
9. Murray WB, Yankelowitz SM, Le Roux M, Bester HF. Prevention of post-tonsillectomy pain with analgesic doses of ketamine. S Afr Med J 1987; 72 (12):839-42.
10. Elhakim M, Abdul Salam AY, Eid A, Kaschef N, Mostafa BE. Inclusion of pethidine in lidocaine for infiltration improves analgesia following tonsillec- tomy in children. Acta Anesthesiol Scand 1997;41 (2):214–7.
11. Khan BA, Guzman O, Campbell NL, Walroth T, Tricker J, Hui SL, et al. Comparison and agreement between the Richmond Agitation-Sedation Scaleand the Riker Sedation-Agitation Scale in evaluating patients' eligibility for delirium assessment
 in the ICU. Chest 2012;142(1):48–54.
12. Engelhardt T, Steel E, Johnston G, Veitch DY. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Paediatr Anaesth 2003;13(3):249–52.
13. Ozalevli M, Unlügenç H, Tuncer U, Güneş Y, Ozcengiz D. Comparison of morphine and tramadol by patient controlled analgesia for postoperative analgesia after tonsillectomy in children. Pediatr Anesth 2005;15(11): 979–84.
14. Chew ST, Ip-Yam PC, Kong CF. Recovery Following Tonsillectomy A Comparison Between Tramadol and Morphine for Analgesia. Singapore Med J 2003; 44(6):296–8.
15. Viitanen H, Annila P. Analgesic efficacy of tramadol 2 mg kg (-1) for paediatric day–case adenoidectomy. Br J Anaesth 2001; 86(4):572–5.
16. Pendeville PE, Von Montigny S, Dort JP, Veyckemans F. Double-blind randomized study of tramadol vs. paracetamol in analgesia after day-case tonsillectomy in children. Eur J Anaesthesiol 2000; 17(9):576–82.
17. Ugur MB, Yilmaz M, Altunkaya H, Cinar F, Ozer Y, Beder L. Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: A double blind randomized placebo-controlled clinical trial. Int J Pediatr Otorhinolaryngol 2008;72(2): 241–8.
18. Atef A Fawaz AA. Peritonsillar in Wltration with tramadol improves pediatric tonsillectomy pain. Eur Arch Otorhinolaryngol 2008; 265(5):571–4.           
19. Elhakim M, Khalafallah Z, El‐fattah H, Farouk S, Khattab A. Ketamine reduces swallowing‐evoked pain after paediatric tonsillectomy. Acta Anaesthesiol Scand 2003;47(5):604–9.
20. Batra YK, Shamsah M, Al-Khasti MJ, Rawdhan HJ, Al-Qattan AR, Belani KG. Intraoperative small-dose ketamine does not reduce pain or analgesic consumption during perioperative opioid analgesia in children after tonsillectomy. Int J Clin Pharmacol There  2007;45(3):155–60.
21. Abu-Shahwan I. Ketamine does not reduce postoperative morphine consumption after tonsillectomy in children. Clin J Pain 2008; 24(5): 395–8.
22. DA Conceição MJ, Bruggemann DA Conceição D, Carneiro Leão C. Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patients. Paediatr Anaesth 2006; 16(9): 962–7.
                      
 
Iranian Journal of Otorhinolaryngology
Volume 27, Issue 6 - Serial Number 6
November and December 2015
Pages 429-434

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