Analgesic Effect of Pre-Incisional Peritonsillar Infiltration of Ketamine for Post-Tonsillectomy Pain in Children

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