Yenigun Alper, Et Tayfun, Aytac Sirin, Olcay Betul
From the *Otorhinolaryngology Clinic; and †Anesthesiology and Reanimation Clinic, Karaman State Hospital, Karaman, Turkey.
J Craniofac Surg. 2015 Jan;26(1):e21-4. doi: 10.1097/SCS.0000000000001250.
Tonsillectomy is the oldest and most frequently performed surgical procedure practiced by ear, nose, and throat physicians. In this study, our aim was to compare the analgesic effects of peritonsillar, rectal, as well as intravenous infiltration of ketamine and intravenous tramadol hydrochloride infiltration for postoperative pain relief and sedation after tonsillectomy in children.
This randomized controlled study evaluated the effects of peritonsillar, intravenous, and rectal infiltration of ketamine in children undergoing adenotonsillectomy. One hundred twenty children who were categorized under American Society of Anesthesiologists classes I to II were randomized to 4 groups of 30 members each. Group 1 received intravenous (IV) ketamine (0.5 mg/kg), group 2 received rectal ketamine (0.5 mg/kg), group 3 received local peritonsillar ketamine (2 mg/kg), and the control group received IV tramadol hydrochloride infiltration (2 mg/kg). Children's Hospital of Eastern Ontario Pain Scale scores and Wilson sedation scale were recorded at minutes 1, 15, 30, 60 as well as hours 2, 12, and 24 postoperatively. The patients were interviewed on the day after the surgery to assess the postoperative pain and sedation.
All the routes of infiltration of ketamine were as effective as those of tramadol hydrochloride (P > 0.05). A statistically significant difference was observed between IV infiltrations and all groups during the assessments at hours 6 and 24. The analgesic efficacy of IV ketamine was found especially higher at hours 6 and 24 (P(6) = 0.045, P(24) = 0.011).
Perioperative, low-dose IV, rectal, or peritonsillar ketamine infiltration provides efficient pain relief without any adverse effects in children who would undergo adenotonsillectomy.
扁桃体切除术是耳鼻喉科医生实施的最古老且最常开展的外科手术。在本研究中，我们的目的是比较氯胺酮扁桃体周注射、直肠给药以及静脉注射和静脉注射盐酸曲马多对儿童扁桃体切除术后疼痛缓解和镇静的镇痛效果。
本随机对照研究评估了氯胺酮在接受腺扁桃体切除术儿童中的扁桃体周、静脉和直肠注射效果。120名美国麻醉医师协会分级为I至II级的儿童被随机分为4组，每组30名成员。第1组接受静脉注射氯胺酮（0.5毫克/千克），第2组接受直肠注射氯胺酮（0.5毫克/千克），第3组接受扁桃体周局部注射氯胺酮（2毫克/千克），对照组接受静脉注射盐酸曲马多（2毫克/千克）。在术后1分钟、15分钟、30分钟、60分钟以及2小时、12小时和24小时记录安大略东部儿童医院疼痛量表评分和威尔逊镇静量表评分。术后第二天对患者进行访谈以评估术后疼痛和镇静情况。
氯胺酮的所有注射途径与盐酸曲马多的效果相同（P>0.05）。在6小时和24小时评估期间，静脉注射与所有组之间观察到统计学上的显著差异。发现静脉注射氯胺酮在6小时和24小时的镇痛效果尤其更高（P(6)=0.045，P(24)=0.011）。
围手术期低剂量静脉、直肠或扁桃体周注射氯胺酮可为接受腺扁桃体切除术的儿童提供有效的疼痛缓解且无任何不良反应。
