Abstract
Introduction: Tonsillectomy in children is associated with some major complications originating from intense post-tonsillectomy pain which can distress patients, cause swallowing difficulties and discomfort, and also lead to aspiration. Thus, this study aimed to investigate the effect of using pre-operative ketamine injection on post-tonsillectomy pain intensity in children.
 Methods: This double-blind clinical trial was carried out on 60 patients undergoing elective tonsillectomy. To this end, all the patients were anaesthetized by the same method. In the first group, 2 cc of ketamine (0.5mg/kg) solution was topically injected into the soft tissue of tonsillar fossa (peritonsillar space); in the second group, a similar administration was performed but with normal saline. For all the patients, incision was made 5 minutes after injection with the Blast Dissection Snare method. Moreover, the patients’ pain intensity and analgesics consumption were measured 30 minutes, and 1, 2, 4, and 6 hours after surgery. Finally, the collected data were analyzed using the SPSS software.
 Results: The present study was conducted on 60 patients, 37 males and 23 females, with the mean age of 9.3±3.4 years. In this respect, repeated measures analysis of variance of patients’ pain scores collected in five post-operative stages showed that pain intensity in both groups was at the highest level immediately after operation; it gradually decreased during measurement stages. However, at each measurement, the pain intensity experienced in the ketamine-treated group was significantly lower than that for the placebo group.
 Conclusion: It was concluded that pre-incision topical injection of ketamine can serve as an effective method to control post-tonsillectomy throat pain.
Highlights
Tonsillectomy in children is associated with some major complications originating from intense post-tonsillectomy pain which can distress patients, cause swallowing difficulties and discomfort, and lead to aspiration
In this respect, repeated measures analysis of variance of patients’ pain scores collected in five post-operative stages showed that pain intensity in both groups was at the highest level immediately after operation; it gradually decreased during measurement stages
This study aimed to investigate the effect of using pre-operative ketamine injection on post-tonsillectomy pain intensity in children
Summary
Tonsillectomy in children is associated with some major complications originating from intense post-tonsillectomy pain which can distress patients, cause swallowing difficulties and discomfort, and lead to aspiration. The most common post-operative effect of tonsillectomy in children is pain (Hanss et al, 2011; Shoar et al, 2012) which is difficult to control both at the hospital and home (Hamunen and Kontinen, 2005). This pain may interfere with oral food intake and delay patient recovery (Giannoni et al, 2001; Hamunen and Kontinen, 2005), and lead to prolonged hospitalization and significant financial burden (Aydin et al, 2007; Javid et al, 2012). Opioids may lead to excessive relaxation and weakness of superior airway muscle, swallowing difficulties, respiratory distress, nausea, vomiting, and aspiration, while non-steroidal analgesics may increase the risk of bleeding, vomiting, and nausea (M?iniche et al, 2003; Safavi et al, 2009; Warncke et al, 1997)
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