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Preoperative Esketamine Alleviates Postoperative Pain after Endoscopic Plasma Adenotonsillectomy in Children

Feng Liu1, Fanli Kong1, Liang Zhong1

  • 1Department of Anesthesiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China.

Clinical Medicine & Research
|July 5, 2023
PubMed

Insights

Preoperative esketamine effectively reduced postoperative pain and inflammatory markers in children undergoing adenotonsillectomy compared to fentanyl. This suggests esketamine is a valuable option for pediatric pain management after this procedure.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pain Management

Background:

  • Pediatric adenotonsillectomy is associated with significant postoperative pain.
  • Effective pain management is crucial for recovery and reducing stress responses in children.

Purpose of the Study:

  • To evaluate the efficacy of preoperative esketamine in alleviating postoperative pain after endoscopic plasma adenotonsillectomy in children.
  • To compare serum c-fos and c-jun levels, and the Face, Legs, Activity, Cry, and Consolability (FLACC) score between esketamine and fentanyl groups.

Main Methods:

  • A randomized controlled trial involving 200 children undergoing adenotonsillectomy.
  • Children received either preoperative esketamine (ESK group) or fentanyl (FEN group).
  • Primary endpoint: serum c-fos and c-jun mRNA levels; Secondary endpoints: FLACC score and adverse events.

Main Results:

  • Both groups showed increased c-fos and c-jun mRNA levels post-surgery, but levels were significantly higher in the fentanyl group (P<0.05).
  • FLACC scores were significantly higher in the fentanyl group at 1 and 24 hours post-surgery (P<0.05).
  • c-fos and c-jun mRNA levels predicted early postoperative pain and stress.

Conclusions:

  • Preoperative esketamine (1mg/kg) effectively alleviates postoperative pain in children undergoing adenotonsillectomy.
  • Esketamine-based anesthesia helps regulate inflammatory responses post-surgery.
  • Esketamine demonstrates potential as a superior analgesic compared to fentanyl for this pediatric surgical procedure.

Keywords:
ChildrenEndoscopic plasma total adenotonsillectomyEsketaminePostoperative painSerum c-fos mRNASerum c-jun mRNA

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