Ketamine for management of re-bleeding due to acute post- tonsillectomy pain in children

Background Tonsillectomy with or without adenoidectomy is a common surgical procedure in children. Severe postoperative pain has been reported in 5 to 20% of children undergoing this operation. Hemorrhage due to posttonsillectomy pain is among the main causes of postsurgical morbidity. This study reviewed the available literature in this regard to determine the efficacy of various doses of ketamine, administration method and its association with other drugs for the management of acute post-tonsillectomy pain and provide a guideline for acute post-surgical pain control. Methods In this narrative review study, double blind randomized clinical trials published during 2002-2013 were collected. After primary assessment, 14 studied were included and post-tonsillectomy analgesia due to administration of ketamine was compared with that of other drugs. Results Of 14 studies evaluated, 9 confirmed the efficacy of ketamine in doses greater than 0.5 mg/kg for posttonsillectomy analgesia. Two studies mentioned the superior analgesic effect of other drugs like tramadol and meperidine. In one study, 0.25 mg/kg ketamine could not decrease the post-operative morphine consumption. In our previous study, 0.25 mg/kg ketamine could decrease post tonsillectomy agitation in children. One study reported that lidocaine spray in the first 20 min following surgery was more effective than morphine or ketamine; but at 60 min, morphine and ketamine caused greater analgesia. Only two studies were mentioned the possible effect of ketamine on bleeding amounts after tonsillectomy. Pediatric Anesthesia and Critical Care Journal 2015; 3(1):41-48 doi:10.14587/paccj.2015.8 Ghanbarpour et al. Ketamine and post-tonsillectomy re-bleeding 42 Conclusions Intravenous, intramuscular, infiltration or spray administration of even a single dose of 0.5 mg/kg ketamine before, during or after surgery could effectively prevent post-operative pain and following bleeding in children who underwent tonsillectomy with or without adenoidectomy.