Combined Ketamine/Bupivacaine Peritonsillar Infiltration Minimized Post-tonsillectomy pain and Postoperative Hospital Stay
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The current study was planned to assess post-tonsillectomy analgesic efficacy of pre-emptive peritonsillar ketamine infiltration with or without bupivacaine in comparison to meperidine alone or in combination with bupivacaine. The study included 100 patients with mean age of 10.5±2.3 years and assigned for adenotonsillectomy. Patients were randomly allocated into 4 groups (n=25): Group Kl: received peritonsillar infiltration of ketamine (0.5 mg/kg), Group MI: received peritonsillar infiltration of meperidine (1 mg/kg), and groups 1(2 and M2 received either ketamine (0.5 mg/kg) or meperidine (I mg/kg) in combination with bupivacaine (5 mg/m1). All medications prepared as 2 ml in volume and were applied as I ml per tonsil 3 min prior to tonsillectomy. On admission to the post-anesthesia care unit (PACU) pain was assessed using the objective pain scale (OPS) score which evaluates 5 parameters each was scored from 0 to 2 for a collective score ranged from 0=best to 10=worst. OPS score was assessed at time of admission to PACU and every 15 min for one hour and every 30 minutes till patients were ready for discharge from PACU at an Aldrete score of 9. Rescue analgesia with morphine 0.05 mg/kg iv. was administered, after operation; for OPS score as and time elapsed till first request of rescue analgesia was determined. Upon patient discharge, parents were asked to rate their satisfaction with patient analgesia on 7-point scale; 1=extremely dissatisfied and 7=extremely satisfied. All enrolled patients passed smooth intraoperative course without complication. Mean duration of PACU stay was significantly shorter in group 1(2 compared to the other 3 groups and in group KI compared to groups MI and M2. Moreover, total hospital stay was significantly shorter in group 1(2 compared to groups MI and M2 but was non-significantly shorter compared to group ICI. Both duration of PACU and hospital stay showed a nonsignificant difference between groups MI and M2. In group KI number of patients had short hospital stay was significantly higher compared to groups MI and M2. Number of patients in group IC2 and had short hospital stay was significantly higher compared to groups MI and M2. Mean recorded OPS scores showed progressive increase in all patients reaching a peak at 90-min after PACU admission in groups K1, MI and M2 and at I20-min in K2 group. At 60- and 90- minutes after admission to PACU patients enrolled in group 1(2 had a significantly lower OPS scores compared to groups KI and MI but non-significantly lower scores compared to group M2. Mean parents' satisfaction scores reported in group 1(2 were significantly higher compared to groups KI and MI and were non-significantly higher compared to group M2 with non-significant difference among the other three groups despite being in favor of group M2. Peritonsillar injection of a combination of bupivacaine and ketarnine provided efficient postoperative analgesia after adenotonsillectomy and achieved higher parents' satisfaction for the outcome of surgery. The used drugs' combination and volume could be recommended as a routine preemptive analgesic policy for children assigned for adenotonsillectomy.