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. |
