Jha Ajay Kumar, Bhardwaj Neerja, Yaddanapudi Sandhya, Sharma Ramesh Kumar, Mahajan Jai Kumar
Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Paediatr Anaesth. 2013 May;23(5):401-6. doi: 10.1111/pan.12124. Epub 2013 Feb 28.
Wound infiltration with ketamine reduces postoperative pain after tonsillectomy by NMDA receptor blockade and local anesthetic effect.
To evaluate the postoperative analgesia after surgical site infiltration with bupivacaine or ketamine in children undergoing cleft palate surgery.
After institutional ethics committee approval and parental consent, 50 ASA-1 children of age 1-6 years undergoing palatoplasty were included in this prospective randomized double-blind study. A standardized technique of general anesthesia was used. The surgical site was infiltrated with either 2 mg·kg(-1) of bupivacaine (Group B) or 0.5 mg·kg(-1) of ketamine (Group K). Pain (Children Hospital Eastern Ontario Pain Score), sedation, dysphagia, nausea, vomiting, and sleep pattern were assessed postoperatively up to 24 h.
CHEOPS scores were similar in both the groups up to 12 h but were lower with ketamine compared with bupivacaine at 24 h postoperatively (P = 0.01). Fewer children required rescue analgesics in Group K (28%) than in Group B (64%; P < 0.01). The time to first rescue analgesic and the amount of analgesics used in 24 h were similar in the two groups. Fewer children suffered from dysphagia in Group K (52%) than in Group B (88%; P < 0.01). More children in Group B had disturbed sleep than in Group K at 6 (88% vs 56%; P = 0.012) and 12 h (60% vs 24%; P = 0.01) postoperatively. None of the children had deep sedation, desaturation or respiratory depression.
Surgical site infiltration with either bupivacaine or ketamine provides adequate analgesia and is devoid of major side effects. Ketamine is superior to bupivacaine in terms of requirement of rescue analgesic, peaceful sleep pattern and early resumption of feeding.
氯胺酮伤口浸润通过阻断NMDA受体和局部麻醉作用减轻扁桃体切除术后疼痛。
评估在腭裂手术患儿中布比卡因或氯胺酮手术部位浸润后的术后镇痛效果。
经机构伦理委员会批准并获得家长同意后，50例年龄1 - 6岁、美国麻醉医师协会（ASA）分级为1级的行腭裂修复术患儿纳入本前瞻性随机双盲研究。采用标准化全身麻醉技术。手术部位分别用2mg·kg⁻¹布比卡因（B组）或0.5mg·kg⁻¹氯胺酮（K组）进行浸润。术后长达24小时评估疼痛（东安大略儿童医院疼痛评分）、镇静、吞咽困难、恶心、呕吐及睡眠模式。
两组在术后12小时内的小儿东安大略儿童医院疼痛评分（CHEOPS）相似，但术后24小时时氯胺酮组低于布比卡因组（P = 0.01）。K组需要补救性镇痛的患儿（28%）少于B组（64%；P < 0.01）。两组首次使用补救性镇痛的时间及24小时内使用的镇痛药物量相似。K组吞咽困难的患儿（52%）少于B组（88%；P < 0.01）。术后6小时（88%对56%；P = 0.012）和12小时（60%对24%；P = 0.01）时，B组睡眠受干扰的患儿多于K组。所有患儿均未出现深度镇静、血氧饱和度降低或呼吸抑制。
布比卡因或氯胺酮手术部位浸润均能提供充分镇痛且无主要副作用。在补救性镇痛需求、睡眠模式良好及早期恢复进食方面，氯胺酮优于布比卡因。
