[Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial]

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Management

Background:

• Nebulized ketamine administration is an emerging technique with limited research.
• Tonsillectomy is a common procedure associated with significant postoperative pain.
• Effective pain management is crucial for pediatric recovery after tonsillectomy.

Purpose of the Study:

• To evaluate the analgesic efficacy of preemptive nebulized ketamine compared to intravenous ketamine and placebo.
• To compare different doses of nebulized ketamine (1 and 2 mg/kg) in pediatric tonsillectomy patients.
• To assess the impact of nebulized ketamine on rescue analgesic consumption and pain scores.

Main Methods:

• A randomized controlled trial involving 100 children (7-12 years) undergoing elective tonsillectomy.
• Four groups were established: Saline placebo, intravenous ketamine (0.5 mg/kg), nebulized ketamine (1 mg/kg), and nebulized ketamine (2 mg/kg).
• The primary outcome was the total consumption of rescue analgesics within 24 hours postoperatively.

Main Results:

• Nebulized ketamine (1 and 2 mg/kg) significantly prolonged the time to first analgesic request compared to placebo (p<0.001).
• Total postoperative paracetamol consumption was reduced in both nebulized and intravenous ketamine groups compared to placebo (p<0.001).
• No significant differences in pain scores or adverse effects were observed between intravenous and nebulized ketamine groups.

Conclusions:

• Preemptive nebulized ketamine demonstrates significant efficacy in managing post-tonsillectomy pain.
• Nebulized ketamine serves as an effective alternative route for pain relief compared to intravenous administration.
• This study supports nebulized ketamine as a promising option for pediatric pain management after tonsillectomy.