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

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.