The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy<sup>1</sup>

Dal, Didem; Çelebi, Nalan; Elvan, Elvan Gaye; Çeliker, Varol; Aypar, Ülkü

doi:10.1111/j.1460-9592.2006.02095.x

Cited by 69 publications

(73 citation statements)

References 21 publications

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“…22 Of the 70 studies meeting inclusion criteria, 64 were suitable for inclusion in the quantitative analysis, and the remaining six were added to the qualitative analysis. These six studies reported data which were not useable in the quantitative analysis, such as median and range (two), mean only (one), mean and range (one), graphical data and SEM (one), and number of events of non-opioid rescue analgesia (one) were initially analyzed quantitatively, an additional 17 studies [70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86] were used to corroborate the results within the quantitative analysis, and the remaining six studies [87][88][89][90][91][92] were added to the qualitative analysis. All 70 studies had either low or unclear risks of bias in all six categories of the Cochrane Collaboration's tool for assessing risk of bias (see Table 1).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of intravenous ketamine for postoperative analgesia

Laskowski

Stirling

McKay

et al. 2011

Can J Anesth/J Can Anesth

501

313

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Purpose Perioperative intravenous ketamine may be a useful addition in pain management regimens. Previous systematic reviews have included all methods of ketamine administration, and heterogeneity between studies has been substantial. This study addresses this issue by narrowing the inclusion criteria, using a random effects model, and performing subgroup analysis to determine the specific types of patients, surgery, and clinical indications which may benefit from perioperative ketamine administration. Source We included published studies from 1966 to 2010 which were randomized, double-blinded, and placebocontrolled using intravenous ketamine (bolus or infusion) to decrease postoperative pain. Studies using any form of regional anesthesia were excluded. No limitation was placed on the ketamine dose, patient age, or language of publication. Principal findings Ninety-one comparisons in seventy studies involving 4,701 patients met the inclusion criteria (2,652 in ketamine groups and 2,049 in placebo groups). Forty-seven of these studies were appropriate for evaluation in the core meta-analysis, and the remaining 23 studies were used to corroborate the results. A reduction in total opioid consumption and an increase in the time to first analgesic were observed across all studies (P \ 0.001). The greatest efficacy was found for thoracic, upper abdominal, and major orthopedic surgical subgroups. Despite using less opioid, 25 out of 32 treatment groups (78%) experienced less pain than the placebo groups at some point postoperatively when ketamine was efficacious. This finding implies an improved quality of pain control in addition to decreased opioid consumption. Hallucinations and nightmares were more common with ketamine but sedation was not. When ketamine was efficacious for pain, postoperative nausea and vomiting was less frequent in the ketamine group. The dose-dependent role of ketamine analgesia could not be determined. Conclusion Intravenous ketamine is an effective adjunct for postoperative analgesia. Particular benefit was observed in painful procedures, including upper abdominal, thoracic, and major orthopedic surgeries. The analgesic effect of ketamine was independent of the type of intraoperative opioid administered, timing of ketamine administration, and ketamine dose. RésuméObjectif La ke´tamine intraveineuse pe´riope´ratoire peut constituer un ajout utile a`l'arsenal the´rapeutique de prise en charge de la douleur. Les revues me´thodiques pre´ce´dentes ont examine´toutes les me´thodes d'administration de la ke´tamine, et l'he´te´roge´ne´ite´entre les e´tudes est conside´rable. Cette e´tude aborde la question en limitant les crite`res d'inclusion, en utilisant un mode`le a`effets ale´atoires et en re´alisant une analyse de sous-groupe afin de de´terminer les types spe´cifiques de patients et de chirurgie ainsi que les indications cliniques qui pourraient be´ne´ficier de l'administration pe´riope´ratoire de ke´tamine.

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Section: Resultsmentioning

confidence: 99%

A systematic review of intravenous ketamine for postoperative analgesia

Laskowski

Stirling

McKay

et al. 2011

Can J Anesth/J Can Anesth

501

313

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“…Ketamine has been used to reduce post-operative pain following various surgical procedures like hernioraphy [20], abdominal hysterectomy [21], thoracotomy [22], circumcision [23], cesarean section [24], open cholecystectomy [25], appendectomy [26], tonsillectomy [27][28][29][30][31]. Recently ketamine has been used in oral and maxillofacial surgical practice as well [14,[32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have evaluated the effectiveness of ketamine administered locally to the peri-tonsillar region following tonsillectomy for postoperative pain management [27][28][29][30][31]. Tan et al [23] gave a subcutaneous ring infiltration of ketamine at the incision site before circumcision surgery and showed that the time interval until first analgesic demand was longer and the incidence of pain-free status during movement and erection was significantly higher than for the saline-treated analogs.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have compared the efficacy of ketamine administered through different routes and the results have been varying [25,38]. Dal et al [28] compared same dose of peritonsillar infiltration of ketamine with iv ketamine and found no statistically significant difference in pain scores in both the groups of patients undergoing adenotonsillectomy. Various sub-anesthetic doses of ketamine have been used by different authors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

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“…Bu çalışmaların çoğunda adenotonsillektomi operasyonları için en yüksek doz olarak 0.5 mg/kg intravenöz ketamin verilerek analjezik etki araştırılmıştır (7,(12)(13)(14)(15). Çalışmamız alt batın cerrahisi geçiren (minör cerrahi) 90 hastada yapılmış olup bu cerrahi tipinde ve bu sayıdaki hasta popülasyonunda yapılan bir adet çalışmaya rastlanmıştır (9).…”

Section: Discussionunclassified

Preemptive Analgesic Effect Of Ketamine In Children With Lower Abdominal Surgery

Beyaz¹

2010

TUTFD

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ÖZETAmaç: Erişkinlerde yapılan klinik çalışmalar düşük doz ketaminin postoperatif ağrı üzerine preemptif analjezik etkiye sahip olduğunu desteklemektedir. Bu çalışmanın amacı çocuklarda alt batın cerrahisinde farklı zamanlarda uygulanan ketaminin preemptif analjezik etkisini değerlendirmektir. Gereç ve Yöntemler:Alt batın cerrahisi operasyonlarında fi ziksel durumu ASA I-II olan, 3-12 yaşlarında 90 çocuk rastgele bir şekilde 3 gruba ayrıldı. Grup pre'ye insizyondan önce intravenöz (i.v.) 1 mg/kg ketamin, Grup int' e insizyondan 10 dk sonra i.v. 1 mg/kg ketamin, Grup post' a ise cerrahi tamamlandıktan sonra i.v. 1 mg/kg ketamin verildi. Bütün hastalara aynı anestezi tekniği uygulandı. Hastaların ağrısı Çocukların ve İnfantların Postoperatif Ağrı Skalası (CHIPPS) ile, sedasyon durumu ise Ramsey Sedasyon Skalasına göre postoperatif 5, 15, 30. dakikalarda ve 1, 3 ve 6. saatlerde değerlendirildi. İlk analjezik gereksinimleri kaydedildi. Bulgular: Gruplar arasında yaş, cinsiyet, vücut ağırlığı, ASA durumu, ameliyat türleri ve ameliyat süreleri bakımından anlamlı bir fark bulunmadı (p>0.05). Grup pre ve Grup int arasında CHIPPS skorları bakımından anlamlı fark bulunmadı (p>0.05). Grup post'da tüm ölçüm zamanlarında CHIPPS skorları diğer gruplara göre düşük bulundu. Gruplar arasında sedasyon düzeyleri değerlendirildiğinde Grup post'de anlamlı olarak yüksek bulundu (p=0.003). Sonuç:Çocuklarda alt batın cerrahisi sırasında 1 mg/kg intravenöz ketaminin operasyon öncesi verilmesinin operasyon sonrası verilmesine göre analjezi ve sedasyon üzerine olumlu bir etkisinin olmadığı görüldü. ABSTRACTObjective: Preemptive analgesic effect of low dose ketamine has been supported by clinical studies in adults. The aim of this study was to evaluate the analgesic effect of ketamine applied at different times in children who underwent lower abdominal surgery. Material and Methods:A total of 90 children having ASAI-II physical status between 3 and 12 was randomly divided into three groups as pre, int and post groups. Ketamine were given to these groups in the following manner respectively; 1mg/kg intravenous ketamine before incision (preincisional); the same dose ketamine 10 minutes following the fi rst incision (intraoperative); and ketamine at the end of the surgical operation (postoperative). The pain of patients was assessed by postoperative pain scale (CHIPPS) in children and infants; the sedation status of children was assessed by Ramsey's sedation scale. The fi rst analgesic requirement time was recorded.Results: No signifi cant difference was found in demographic characteristics of the three groups (p>0.05). Lower CHIPPS scores were found in Group Post throughout all measurement periods (p<0.05). Group Post was found to have signifi cantly higher sedation levels compared with the other two groups (p=0.003). Conclusion:No analgesic effect was obtained using by pre-incisional and intraoperative i.v.1mg/kg ketamine, during lower abdominal surgery in children. Further studies with different drugs are needed to clarify this topic. Gi...

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The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy¹

Abstract: Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy.

Cited by 69 publications

References 21 publications

A systematic review of intravenous ketamine for postoperative analgesia

A systematic review of intravenous ketamine for postoperative analgesia

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Preemptive Analgesic Effect Of Ketamine In Children With Lower Abdominal Surgery

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The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy1

Abstract: Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy.

Cited by 69 publications

References 21 publications

A systematic review of intravenous ketamine for postoperative analgesia

A systematic review of intravenous ketamine for postoperative analgesia

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Preemptive Analgesic Effect Of Ketamine In Children With Lower Abdominal Surgery

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The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy¹