The analgesic effi cacy of preincisional peritonsillar versus intravenous ketamine with bupivacaine infi ltration for tonsillectomy in children : a randomized double-blind controlled study

الملخص EN

Objective This study aimed to evaluate the postoperative analgesic effi cacy of either preincisional peritonsillar infi ltration of ketamine in combination with bupivacaine, or intravenous ketamine combined with infi ltration of bupivacaine.

Patients and methods A total of 60 patients were randomized into three groups: intravenous group, in which patients received intravenous ketamine (0.5 mg/kg) in 10 ml plus peritonsillar infi ltration of bupivacaine 2 ml (5 mg/ml); infi ltration group, in which patients received peritonsillar infi ltration of ketamine (0.5 mg/kg) in 2 ml plus bupivacaine 2 ml and intravenous 10 ml saline; and placebo group, in which patients received 10 ml intravenous saline and peritonsillar infi ltration of 2 ml saline plus 2 ml bupivacaine 2 ml/tonsil.

The Children’s Hospital of Eastern Ontario Pain Scale ( CHEOPS) and Wilson scale were used to evaluate pain and sedation, respectively.

Time to fi rst analgesic request and total analgesic request, total analgesic consumption during 24 h postoperatively, intraoperative blood loss, and adverse effects were evaluated.

Results Time to analgesic request was signifi cantly prolonged in the intravenous and infi ltration groups (4.3 ± 2.1 and 11.6 ± 3.6 h, respectively) compared with the placebo group (1.2 ± 1.2 h), with signifi cant prolonged time in the infi ltration group compared with the intravenous group.

Signifi cant lower (CHEOPS) scores and signifi cant lower analgesic consumption were observed in the intravenous and infi ltration groups (69 ± 4.1 and 45.1 ± 2.1 mg), respectively, compared with the placebo group (90.6 ± 5.3 mg).

Both the intravenous and infi ltration groups had comparable pain scores, with statistical signifi cance at 4, 6, and 8 h postoperatively.

Dysphagia was signifi cantly higher in the placebo group compared with the intravenous and infi ltration groups.

No serious complication was reported in the three groups.

Conclusion Intravenous or peritonsillar infi ltration of ketamine with bupivacaine enhanced post-tonsillectomy analgesia in children.

In comparison, the analgesic effi cacy of infi ltration of ketamine was superior to intravenous administration, without signifi cant side effects.