Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.04.005
Brazilian Journal of Anesthesiology
Scientific Article

Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial

Uso preventivo de cetamina nebulizada para controle da dor após amigdalectomia em crianças: estudo randômico e controlado

Hala S. Abdel-Ghaffar, Amani H. Abdel-Wahab, Mohammed M. Roushdy, Amira M.M. Osman

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Abstract

Objectives: The administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2 mg.kg−1) administered 30 min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5 mg.kg−1) and saline placebo. Methods: One hundred children aged (7---12) years were randomly allocated in four groups (n = 25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5 mg.kg−1 (Group K-IV), Nebulized Ketamine 1 mg.kg−1 (Group K-N1) or 2 mg.kg−1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24 h postoperative. Results: The mean time to first request for rescue analgesics was prolonged in K-N1 (400.9 ± 60.5 min, 95% CI 375.9---425.87) and K-N2 (455.5 ± 44.6 min, 95% CI 437.1---473.9) groups compared with Group K-IV (318.5 ± 86.1 min, 95% CI 282.9---354.1) and Group C (68.3 ± 21.9 min, 95% CI 59.5---77.1; p < 0.001), with a significant difference between K-N1 and K-N2 Groups (p < 0.001). The total consumption of IV paracetamol in the first 24 h postoperative was reduced in Group K-IV (672.6 ± 272.8 mg, 95% CI 559.9---785.2), Group K-N1 (715.6 ± 103.2 mg, 95% CI 590.4---840.8) and Group K-N2 (696.6 ± 133.3 mg, 95% CI 558.8---834.4) compared with Control Group (1153.8 ± 312.4 mg, 95% CI 1024.8---1282.8; p < 0.001). With no difference between intravenous and Nebulized Ketamine Groups (p = 0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p < 0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. Conclusion: Preemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine

Keywords

Children; Tonsillectomy; Analgesia; IV ketamine; Nebulized ketamine

Resumo

Objetivos: A administração de cetamina por via inalatória através de nebulizador é relativamente nova e os estudos sobre este assunto são escassos. Nosso objetivo foi investigar a eficácia analgésica da cetamina nebulizada (1 e 2 mg.kg−1) administrada 30 minutos antes da anestesia geral em crianças submetidas à amigdalectomia eletiva, em comparação com cetamina intravenosa (0,5 mg.kg−1) e placebo (soro fisiológico). Métodos: Cem crianças com idades entre 7---12 anos foram randomicamente alocadas em quatro grupos (n = 25) e receberam: soro fisiológico para controle (Grupo C); 0,5 mg.kg−1 de cetamina intravenosa (Grupo C-IV); 1 mg.kg−1 de cetamina nebulizada (Grupo C-N1); 2 mg.kg−1 de cetamina nebulizada (Grupo C-N2). O desfecho primário foi o consumo total de analgésicos de resgate nas primeiras 24 horas de pós-operatório. Resultados: O tempo médio para a primeira solicitação de analgésicos de resgate foi prolongado nos grupos C-N1 (400,9 ± 60,5 min, IC 95% 375,9---425,87) e C-N2 (455,5 ± 44,6 min, IC 95% 437,1---473,9) em comparação com o Grupo C-IV (318,5 ± 86,1 min, IC 95% 282,9---354,1) e o Grupo C (68,3 ± 21,9 min, IC 95% 59,5---77,1; p < 0,001), com uma diferença significativa entre os grupos C-N1 e C-N2 (p < 0,001). O consumo total de paracetamol IV nas primeiras 24 horas de pós-operatório foi reduzido no Grupo C-IV (672,6 ± 272,8 mg, IC 95% 559,9---785,2), Grupo C-N1 (715,6 ± 103,2 mg, IC 95% 590,4---840,8) e Grupo C-N2 (696,6 ± 133,3 mg, IC 95% 558,8---834,4) em comparação com o Grupo C (1153,8 ± 312,4 mg, IC 95% 1024,8---1282,8; p < 0,001). Não houve diferença entre os grupos de cetamina intravenosa e nebulizada (p = 0,312). Os pacientes dos grupos de cetamina intravenosa e nebulizada apresentaram escores VRS pós-operatórios menores, em comparação com o Grupo C (p < 0,001), sem diferenças entre os grupos C-IV, C-N1 ou C-N2 e sem efeitos adversos significativos. Conclusão: A administração preventiva de cetamina nebulizada foi eficaz no alívio da dor pós-amigdalectomia. Cetamina nebulizada pode ser considerada como uma via alternativa eficaz à cetamina IV.

Palavras-chave

Crianças; Amigdalectomia; Analgesia; Cetamina IV; Cetamina nebulizada

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