Objective: Two different concentrations of ketamine 0.5 mg/kg, 0.25 mg/kg were applied to both tonsils perioperatively to check analgesic effect postoperatively in children. This study done at Department of anesthesia and otorhinolaryngology, faculty of medicine, Al-Azhar University hospitals, and the medical ethics committee. The study was conducted in the ENT operating theatre, Al-Azhar University Hospitals, from Jan. 2017 to June 2018. Methodology: We divided patients into 3 groups K1, K2 and S each group 25 patients, group K1 had 0.25 mg ketamine, group k2 had 0.5 mg ketamine and group S had normal saline as a control group. These groups assessed intraoperatively by Heart rate and main arterial pressure (MAP) were recorded at the intervals together with Ventilation parameters. Postoperative pain assessment by using Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS). The sedative condition was assessed with the Wilson sedation scale at 5, 15, 30, and 60 min after entrance to the PACU. CHEOPES was recorded only when patient modified Wilson sedation score was one. Incidences of postoperative complications as: blood loss, dysphagia, nausea and vomiting were noted and demonstrated; hallucinations will be observed and recorded. Results: There were no significant differences among the groups regarding age, gender and weight. There were no significant differences among the groups with respect to the demographic data, duration of surgery or anesthesia, and intraoperative blood loss. As regarding hemodynamics, mean blood pressure was significantly lower in group (K1) than group S (control group) at 20 and 30 minutes after injection of ketamine and significantly lower in group (K2) than group S (control group) at 20 and 30 minutes after injection of ketamine with no difference between group (K1) and (K2). There was a significant statistical difference in analgesia duration per hours and frequency of analgesics used over 24 hours between three groups, the duration was longer in group (K1) and (K2) and frequency of analgesics used over 24 hours (P value < 0.05). Regarding postoperative complications, there was no significant statistical differences as regard nausea and vomiting, but the percentage of dysphagia is significantly higher in group S (control group) than group (K1) and group (K2). Conclusions: In our study, we found that preincisional peritonsillar infiltration of 0.25 mg/kg or 0.5 mg/kg of ketamine given at approximately three minutes before surgery provides efficient pain
References
[1]
Astuto, M., Rosano, G., Rizzo, G., Disma, N. and di Cataldo, A. (2007) Methodologies for the Treatment of Acute and Chronic Nononcologic Pain in Children. Minerva Anestesiologica, 73, 459-465.
[2]
Desborough, J.P. (2000) The Stress Response to Trauma and Surgery. British Journal of Anaesthesia, 85, 109-117. https://doi.org/10.1093/bja/85.1.109
[3]
Ulius, D. and Basbaum, A.I. (2001) Molecular Mechanisms of Nociception. Nature, 413, 203-210.
[4]
Kissin, I. (2005) Preemptive Analgesia at the Cross Road. Anesthesia & Analgesia, 100, 754-756. https://doi.org/10.1213/01.ANE.0000144429.39988.9B
[5]
Ravi, R. and Howell, T. (2007) Anesthesia for Pediatric Ear, Nose and Throat Surgery. Continuing Education in Anaesthesia, Critical Care & Pain, 7, 33-37. https://doi.org/10.1093/bjaceaccp/mkm004
[6]
Atef, A. and Fawaz, A.A. (2008) Peritonsillar Infiltration with Tramadol Improves Pediatric Tonsillectomy Pain. European Archives of Otorhinolaryngology, 265, 571-574. https://doi.org/10.1007/s00405-007-0479-6
[7]
Molliex, S., Haond, P., Baylot, D., Navez, M. and Elkhoury, Z. (2010) Effect of Pre-vs. Postoperative Tonsillar Infiltration with Local Anesthetics on Postoperative Pain after Tonsillectomy. Acta Anaesthesiologica Scandinavica, 40, 1210-1215.
[8]
Romsing, J., Dstergaard, D., Drozdziewicz, D. and Ravn, G. (2000) Diclofenac or Acetaminophen for Analgesia in Pediatric Tonsillectomy in Out-Patients. Acta Anaesthesiologica Scandinavica, 44, 291-295. https://doi.org/10.1034/j.1399-6576.2000.440312.x
[9]
Moiniche, S., Romsing, J., Dahl, J.B. and Tramer, M.R. (2003) Non-Steroidal Anti-Inflammatory Drugs and the Risk of Operative Site Bleeding after Tonsillectomy: A Quantitative Systemic Review. Anesthesia & Analgesia, 96, 68-77. https://doi.org/10.1213/00000539-200301000-00015
[10]
Murray, W.B., Yankelowitz, S.M. and Bester, H.F. (1987) Prevention of Post Tonsillectomy Pain with Analgesic Doses of Ketamine. South African Medical Journal, 72, 839-842.
[11]
Fisher, K., Coderre, T.J. and Hagen, N.A. (2000) Targeting the N-Methyl Daspartate Receptor for Chronic pain Management: Preclinical Animal Studies, Recent Clinical Experience and Future Research Directions. Journal of Pain and Symptom Management, 20, 358-373. https://doi.org/10.1016/S0885-3924(00)00213-X
[12]
Miller, R.D., Eriksson, L.I. and Fleisher, L.A. (2010) Miller’s Anesthesia. 7th Edition, Churchill Living Stone, Philadelphia, 2757-2781.
[13]
McGrath, P.J., Johnson, G. and Goodman, J. (1985) The CHEOPS: A Behavioral Scale for Rating Postoperative Pain in Children. In: Fields, H.L., Dubner, R., Cervero, F., Eds., Advances in Pain Research and Therapy, Raven Press, New York, 395-402.
[14]
Cindoruk, M. and Karakan, T. (2006) Management of Cervical Esophageal Strictures with Self-Expanding Metalic Stents. The Turkish Journal of Gastroenterology, 17, 294-297.
[15]
Wilson, E., David, A., MacKenzie, N. and Grant, I.S. (1990) Sedation during Spinal Anaesthesia: Comparison of Propofol and Midazolam. British Journal of Anaesthesia, 64, 48-52. https://doi.org/10.1093/bja/64.1.48
[16]
O’Flaherly, J.E. and Lin, C.X. (2003) Does Ketamine or Magnesium Effect Post Tonsillectomy Pain in Children? Pediatric Anesthesia, 13, 413-421. https://doi.org/10.1046/j.1460-9592.2003.01049.x
[17]
Rosen, G.M., Muckle, R., Mahowald, M.W., Goding, G.S. and Ullevig, C. (1994) Postoperative Respiratory Compromise in Children with Obstructive Sleep Apnea Syndrome: Can It Be Anticipated? Pediatrics, 93, 784-788.
[18]
Negus, B.H. and Street, N.E. (1995) Midazolam-Opioid Combination and Postoperative Upper Airway Obstruction in Children. Anaesthesia and Intensive Care, 2, 232-233.
[19]
Marret, E., Flahault, A., Samama, C.M. and Bonnet, F. (2003) Effects of Postoperative, Non-Steroidal, Anti-Inflammatory Drugs on Bleeding Risk after Tonsillectomy: Meta-Analysis of Randomized Controlled Trials. Anesthesiology, 98, 1497-1501. https://doi.org/10.1097/00000542-200306000-00030
[20]
Dahmani, S., Michelet, D., Wood, C. and Nivoche, Y. (2011) Ketamine for Perioperative Pain Management in Children: Meta-Analysis of Randomized Controlled Studies. Paediatric Anesthesia, 21, 636-652.
[21]
Honarmand, A. and Reza, M. (2008) The Preventative Analgesic Effect of Preincisional Peritonsillar Infiltration of Two Doses of Ketamine for Postoperative Pain Relief in Children Following Adenotonsillectomy. Pediatric Anesthesia, 18, 508-514. https://doi.org/10.1111/j.1460-9592.2008.02461.x
[22]
Heidari, S.M., Mirlohi, S.Z. and Hashemi, S.J. (2012) Comparison of the Preventive Analgesic Effect of Rectal Ketamine and Rectal Acetaminophen after Pediatric Tonsillectomy. International Journal of Preventive Medicine, 3, S150-S155.
[23]
Dal, D., Celebi, N., Elvan, E.G., Celiker, V. and Aypar, U. (2007) The Efficacy of Intravenous or Peritonsillar Infiltration of Ketamine for Postoperative Pain Relief in Children Following Adenotonsillectomy. Pediatric Anesthesia, 17, 263-269.
