KETAMINE IMPROVES POSTOPERATIVE PAIN AND EMERGENCE AGITATION FOLLOWING ADENOTONSILLECTOMY IN CHILDREN. A RANDOMIZED CLINICAL TRIAL

Background: Management of postoperative pain and emergence agitation following adenotonsillectomy in pediatrics has been a major challenge for anesthesiologists. Although analgesic sparing effect of ketamine has been studied during tonsillectomy in pediatrics, there is a lot of controversy about its efficacy. Present study was designed to evaluate the effect of intravenous low dose ketamine (0.25mg/kg) during induction of anesthesia on postoperative pain and emergence agitation following adenotonsillectomy in children. Methods: In this randomized clinical trial 66 children aged 5 to 15 years who underwent elective adenotonsillectomy were randomly allocated into two groups. Patients in the control group received 5ml of normal saline while patients in the ketamine group received 0.25 mg/kg of ketamine in 5 ml volume during induction of anesthesia. After termination of surgeries and transferring the patients to recovery, emergence agitation, pain score, paracetamol requirements and incidence of postoperative nausea vomiting were assessed every hour for 6 hours. Results: Emergence agitation score was significantly lower in the ketamine group (P =0.002). Pain score at all hours was lower in the ketamine group than the control group (P 0.05). The requirements for intravenous paracetamol were significantly lower in the ketamine group (P=0.0036). There was no difference in the incidence of postoperative nausea and vomiting between the two groups (P=0.99). Conclusion: Low-dose ketamine during induction of anesthesia improves emergence agitation and postoperative pain following adenotonsillectomy in children.