Topical ketamine and morphine for post-tonsillectomy pain.
OBJECTIVE
Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesics. Despite the use of different surgical and anaesthetic techniques in the search for safe and effective post-tonsillectomy pain relief, this problem remains a clinical dilemma. The aim of the current study was to evaluate the potential effects of topically administered ketamine and morphine by an oral rinse into the tonsillar fossae.


METHODS
In all, 60 children, 15 for each group, aged between 3 and 12 yr scheduled for tonsillectomy were randomly assigned to one of four groups. Study drugs were administered to both tonsillar fossae for 5 min. Group K received 0.4 mL (20 mg) ketamine in 10 mL artificial saliva, Group KM received 0.4 mL (20 mg) ketamine + 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group M received 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group C received only 10 mL artificial saliva. Postoperative pain, nausea, vomiting, sedation and bleeding were evaluated.


RESULTS
Pain scores were higher in the control group at arrival in the recovery ward (P < 0.05). Morphine and ketamine groups had longer effective analgesia time than the morphine + ketamine and control groups. The 24-h analgesic consumption was significantly higher in the control group.


CONCLUSIONS
Topical ketamine and morphine seems to be a safe and easy analgesic approach for decreasing adenotonsillectomy pain.
Canbay
O
O
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology, Sihhiye, Ankara, Turkey. ozgurcanbay@yahoo.com
Celebi
N
N
Uzun
S
S
Sahin
A
A
Celiker
V
V
Aypar
U
U
D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009067:Mouthwashes; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012464:Saliva, Artificial; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects
D000700:Analgesics; D000701:Analgesics, Opioid; D009067:Mouthwashes; D012464:Saliva, Artificial; D007649:Ketamine; D009020:Morphine