Abstract
Background and objectivesThe goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.Subjects and MethodsTwo authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0–24 hours after leaving the operation room were included in the analysis.ResultsThe pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.ConclusionPreoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.
Highlights
Tonsillectomy continues to be one of the most common otorhinolaryngology surgical procedures for children
Many therapeutic modalities ranging from nonsteroidal anti-inflammatory agents (NSAIDs), systemic opioids and local anesthetics have been used in children as effective means for post tonsillectomy pain control [3]
Full text of studies that were potentially relevant to the topic were obtained if a decision for inclusion could not be made from the abstract alone
Summary
Tonsillectomy continues to be one of the most common otorhinolaryngology surgical procedures for children. Despite advancements in surgical and anesthetic techniques, severe pain and difficulty swallowing are common complaints encountered in children [1,2]. Many therapeutic modalities ranging from nonsteroidal anti-inflammatory agents (NSAIDs), systemic opioids and local anesthetics have been used in children as effective means for post tonsillectomy pain control [3]. NSAIDs cause less drowsiness, respiratory depression, and vomiting, but they may interfere with bleeding [4]. The goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children
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