Comparison of effect of intravenous ketamine, peritonsillar infiltration of tramadol and their combination on pediatric post-tonsillectomy pain: A double-blinded randomized placebo-controlled clinical trial

Abstract

In this study, the aim was the evaluation of effect of intravenous (IV) administration of ketamine, peritonsillar infiltration of tramadol and their combination for control of post-operative pain in comparison with single use of each drug in children undergoing tonsillectomy. One hundred and twenty children, aged 2-15 years, selected for elective adenotonsillectomy were enrolled in the study. We divided the patients into four groups of 30 each, Group I: received IV ketamine 0.5 mg/kg, Group II: received peritonsillar infiltration of tramadol 2 mg/kg, Group III: received IV ketamine 0.5 mg/kg added to peritonsillar tramadol 2 mg/kg and Group IV: received IV and peritonsillar infiltration of 0.9% saline. We utilized the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) recorded each 15 min after surgery to the   first h and then each 2 , 4, 6, 8, 16, 24 h to assess pain levels postoperatively. The analysis of data showed that Group III had significantly lower CHEOPS scores than another three groups (P<0.001), while both Groups I and II had the same ranged scores, which were not statistically significant (P>0.05). During 24 h after surgery, the first time for analgesic requirement was higher in Group III in comparison with other groups (P<0.001). Combined use of IV ketamine 0.5 mg/kg with peritonsillar infiltration of tramadol 2 mg/kg provided better and more prolong analgesic effects compared with using each drug alone in patients undergoing tonsillectomy.