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Published on: November 6, 2019
Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis
Hye Kyung Cho1, Kyu Won Kim1, Yeon Min Jeong2
1Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea.
Insights
Ketamine effectively reduces postoperative pain and analgesic needs in children after tonsillectomy, with no increased adverse effects compared to controls. Local ketamine administration appears most effective for pain relief.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Tonsillectomy is a common pediatric surgical procedure associated with significant postoperative pain.
- Effective pain management is crucial for optimal recovery and patient satisfaction following tonsillectomy.
- The role of ketamine in managing pediatric postoperative pain requires systematic evaluation.
Purpose of the Study:
- To systematically review and meta-analyze the effects of ketamine on postoperative pain intensity and adverse events in children undergoing tonsillectomy.
- To compare ketamine administration with placebo (no treatment) and opioid analgesia for pain control.
- To assess the impact of different ketamine administration methods (systemic vs. local) on pain outcomes.
Main Methods:
- A systematic literature search was conducted across MEDLINE, SCOPUS, and Cochrane databases up to February 2014.
- Studies comparing preoperative ketamine with control or opioid groups were included.
- Outcomes assessed included postoperative pain scores, analgesic consumption, and adverse effects within 24 hours post-surgery.
Main Results:
- Ketamine significantly decreased postoperative pain scores and analgesic requirements compared to the control group.
- Ketamine's efficacy in pain reduction was comparable to opioid administration.
- No significant differences in adverse effects were observed between ketamine and control groups.
- Peritonsillar infiltration of ketamine demonstrated superior efficacy in reducing pain and analgesic needs compared to systemic administration.
Conclusions:
- Preoperative ketamine, administered systemically or locally, offers effective pain relief with minimal side effects in pediatric tonsillectomy patients.
- Further high-quality clinical trials are warranted to confirm these findings, particularly regarding optimal administration methods and addressing heterogeneity.
- Ketamine presents a promising alternative or adjunct for managing postoperative pain in pediatric tonsillectomy.
Background And Objectives:
The goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.
Subjects And Methods:
Two authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0-24 hours after leaving the operation room were included in the analysis.
Results:
The pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.
Conclusion:
Preoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.
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