Comparison of Nebulized Ketamine with Intravenous Paracetamol Versus Paracetamol Alone For Post-Operative Analgesia In Pediatric Day Care Anesthesia
DOI:
https://doi.org/10.51253/pafmj.v76i1.10665Keywords:
Analgesia, Day-care anesthesia, Ketamine, Nebulized, Paracetamol, TonsillectomyAbstract
Objective: To compare the analgesic efficacy of nebulized Ketamine with intravenous Paracetamol versus Paracetamol alone for post-operative analgesia in pediatric cases undergoing general anesthesia for elective tonsillectomy as a day care procedure
Study Design: Quasi-experimental study
Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, Pakistan from Jan-Jul 2022.
Methodology: Participants in Group-K received intravenous Paracetamol 10 mg/kg with nebulized Ketamine 2 mg/kg diluted in 5 ml given over 5 minutes 15 minutes before induction whereas Group-P received intravenous Paracetamol 15 mg/kg with nebulization with 5 ml Normal Saline as placebo 15 minutes before the procedure.
Results: Post-operative median pain scores calculated in the recovery showed median pain score of 4.00 (IQR=0.00) in Group-P versus 2.00 (IQR=0.00) in Group- K (p<0.001) assessed at 30 minutes. The same scores assessed at 60 minutes showed median pain score of 6.00 (IQR=0.00) in Group-P versus 4.00 (IQR=0.00) in Group -K (p<0.001) and pain scores at 120 minutes showed median score of 6.00 (IQR=0.00) in Group-P versus 4.00 (IQR=2.00) in Group-K (p<0.001).
Conclusion: We conclude that nebulized Ketamine offers better analgesia with improved pain scores and better per-operative hemodynamic stability when compared with NSAIDs alone.
Downloads
References
Cote C, Lerman J, Anderson B. Coté and Lerman's :A practice of anesthesia for infants and children: 6th Ed. Philadelphia Elsevier; 2019.
2. Grubb TL, Perez Jimenez TE, Pettifer GR. Neonatal and pediatric patients. Veterinary Anesthesia and Analgesia: Lumb and Jones: 5th Ed; 2015: 983-987.
3. Butz SF. Pediatric ambulatory anesthesia challenges. Anesthesiol Clin 2019; 37(2): 289-300.
https://doi.org/10.1016/j.anclin.2019.01.002
4. Almaz ME, Oba AA, SÖNMEZ IŞ. Postoperative morbidity in pediatric patients following dental treatment under general anesthesia. Eur Oral Res 2019; 53(3): 113-118.
https://doi.org/10.26650/eor.20190023
5. Suandika M, Muti RT, Tang W-R, Haniyah S, Astuti D. Impact of Opioid-Free Anesthesia on Nausea, Vomiting and pain Treatment in Perioperative Period: A Review. Bali Med J 2021; 10(3): 1408-1414.
6. Cravero JP, Agarwal R, Berde C, Birmingham P, Coté CJ, Galinkin J, et al. The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period. Paediatr Anesthes 2019; 29(6): 547-571.
https://doi.org/10.1111/pan.13639
7. Siu EY, Moon TS. Opioid-free and opioid-sparing anesthesia. Int Anesthesiol Clin 2020; 58(2): 34-41.
https://doi.org/10.1097/aia.0000000000000270
8. Abdel-Ghaffar HS, Abdel-Wahab AH, Roushdy MM, Osman AM. Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial. Braz J Anesthesiol 2019; 69: 350-357.
https://doi.org/10.1016/j.bjane.2019.04.005
9. Šumilo D, Nichols L, Ryan R, Marshall T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract 2019; 69(678): e33-e41.
https://doi.org/10.3399/bjgp18X699833
10. Fang L, Wang Q, Xu Y. Postoperative Discharge Scoring Criteria After Outpatient Anesthesia: A Review of the Literature. J PeriAnesth Nurs 2023: 38(4): 642-649.
https://doi.org/10.1016/j.jopan.2022.11.008
11. Chandran R. Pain assessment in children using a modified wong baker faces pain rating scale. Int J Clin Prevent Dent 2019; 15(4): 202-205.
https://doi.org/10.15236/ijcpd.2019.15.4.202
12. Bhatia A, Buvanendran A. Anesthesia and postoperative pain control—multimodal anesthesia protocol. J Spine Surg 2019; 5(Suppl 2): S160-S165.
https://doi.org/10.21037%2Fjss.2019.09.33
13. Smith Jr TW, Wang X, Singer MA, Godellas CV, Vaince FT. Enhanced recovery after surgery: a clinical review of implementation across multiple surgical subspecialties. Am J Surg 2020; 219(3): 530-534.
https://doi.org/10.1016/j.amjsurg.2019.11.009
14. Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesthesiol Res Pract 2020; 2020: 5798285.
https://doi.org/10.1155/2020/5798285
15. Mehrotra S. Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting. Indian J Anaesth 2019; 63(9): 763-770.
https://doi.org/10.4103%2Fija.IJA_391_19
16. Dove D, Fassassi C, Davis A, Drapkin J, Butt M, Hossain R, et al. Comparison of nebulized ketamine at three different dosing regimens for treating painful conditions in the emergency department: a prospective, randomized, double-blind clinical trial. Ann Emerg Med 2021; 78(6): 779-787.
https://doi.org/10.1016/j.annemergmed.2021.04.031
17. Zanaty OM, El Metainy SA. A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery. Anesth Analg 2015; 121(1): 167-171.
https://doi.org/10.1213/ane.0000000000000728
18. Zia R, Iqbal S, Khan MBA, Butt MM, Nazeer T, Hanif MZ. Post Operative Sore Throat (POST), Comparison Between Nebulization with Ketamine and Placebo. Pak J Med Health Sci 2022; 16(5): 1036-1038.
https://doi.org/10.53350/pjmhs221651036
19. Kuriyama A, Maeda H, Sun R. Aerosolized corticosteroids to prevent postoperative sore throat in adults: A systematic review and meta‐analysis. Acta Anaesthesiol Scand 2019; 63(3): 282-291. https://doi.org/10.1111/aas.13275
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Hassan Nasir Minhas, Nabeel Tahir Butt, Chaudhry Raheel Ranjha, Muhammad Rashid Iqbal, Mobeen Ikram, Qaim Ali Bhatty
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
