Abstract
Objective: Acute pain is a common complication in children undergoing surgery. Acute pain and delirium are associated with agitated behavior, in which there is a risk that the patient causes harm to himself and others. Acute pain and delirium also dissatisfy parents and caregivers during recovery, prolong the recovery and hospitalization, and make more nursing care necessary.
 
 Material and Methods: In this study, 90 ASA I children, aged 3-8, and two candidates for elective inguinal hernia surgery were divided into three groups based on a random number table using block size of four. Parental permission was obtained beforehand. In group 1, 1mg/kg of ketamine (3cc) was administered orally. In group 2, 0.5mg/kg of ketamine was administered subcutaneously after the anesthetic induction. In Group 3, or control group, the same amount of normal saline was administered as the placebo, then the surgery got underway.
 
 Results: Comparing the administration of oral ketamine, subcutaneous ketamine and normal saline, the study showed that the pain was significantly higher in the placebo group at 30, 60, 90 and 120 minutes. Subcutaneous ketamine resulted in higher delirium at 30, 60, 90 and 120 minutes than the placebo and oral ketamine. Satisfaction of nurses from the patient’s recovery was significantly higher in the oral ketamine group and subcutaneous ketamine group (p=0/007). The need for narcotics in the oral ketamine group and subcutaneous ketamine group was lower than the placebo group (p=0/001). Ketamine administration prolonged the length of stay in the PACU, but it did not increase the frequency of complications such as postoperative nausea and vomiting and laryngospasm or bronchospasm in the two groups during the recovery.
 
 Conclusion: In conclusion, the study indicated that oral administration of low-dose ketamine before surgery can reduce pain severity and spare the need for analgesics after surgery.
Highlights
Acute pain is a common complication in children undergoing surgery
Comparing the administration of oral ketamine, subcutaneous ketamine and normal saline, the study showed that the pain was significantly higher in the placebo group at 30, 60, 90 and 120 minutes
Subcutaneous ketamine resulted in higher delirium at 30, 60, 90 and 120 minutes than the placebo and oral ketamine
Summary
Acute pain is a common complication in children undergoing surgery. Acute pain and delirium are associated with agitated behavior, in which there is a risk that the patient causes harm to himself and others. Failure to manage post-operative pain may result in a range of acute and chronic effects. Painful stimulus transmission from peripheral nerves to CNS results in endocrine stress response. This leads to sodium and water entrapment and an increase in glucose, free fatty acids, ketone body, and blood lactate. Managing acute post-operative pain and preventing its occurrence can have a significant role in shortening short-term and long-term recovery. Several factors such as age, physical condition, underlying diseases, type of surgery, fear and anxiety and psychological condition play a role in the occurrence and severity of postoperative jmbr.ccsenet.org
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