Abstract No.: ABS2768: Comparison of pre-emptive ketamine nebulisation with intravenous ketamine for post-operative analgesia in children undergoing tonsillectomy: A randomised controlled trial

BACKGROUND AND AIMS: Nebulised ketamine is a painless route of drug administration in children.This study aimed to compare the effectiveness of ketamine nebulisation as opposed to intravenous ketamine as premedication in children METHODS: 64 children aged 5-10 years, undergoing tonsillectomy were randomly allocated into 2 groups.Both groups received glycopyrrolate 5mcg/kg. First group received ketamine nebulisation (1mg/kg) 20minutes prior to the surgery and other group received intravenous ketamine (1mg/kg) just before shifting to operating room. Children were anaesthetised by standard technique using fentanyl 1 µg/kg, propofol 2mg/kg, atracurium 0.5mg/kg and sevoflurane. Postoperatively, pain score using verbal rating scale(VRS) was assessed immediately after shifting to post anaesthesia care unit (PACU)and after one hour and the time of first rescue analgesic requirement was noted. Children were also assessed for parental separation scores and levels of sedation using 5-point sedation scale preoperatively. RESULTS: There was no difference in VRS pain score immediately after shifting to PACU but there was significant difference in the VRS pain score at one hour postoperatively (p<0.05).The mean time for rescue analgesia was significantly prolonged in ketamine nebulisation group (300±26.40min) in contrast to intravenous ketamine group (237.19±34.38min) (p<0.05). Nebulised and intravenous ketamine produced similar levels of sedation (score-2) and acceptable parental separation scores (score1,2) (table 1). CONCLUSION: Ketamine nebulisation (1mg/kg) administered before tonsillectomy significantly prolonged postoperative analgesia as opposed to intravenous ketamine with similar parental separation scores and sedation scores. Hence nebulisation can be used as an alternative route for administering ketamine.