title: A randomized study of surgical site infiltration with bupivacaine or ketamine for pain relief in children following cleft palate repair.
abstract: BACKGROUND
  Wound infiltration with ketamine reduces postoperative pain after tonsillectomy by NMDA receptor blockade and local anesthetic effect.
  
  
  OBJECTIVE
  To evaluate the postoperative analgesia after surgical site infiltration with bupivacaine or ketamine in children undergoing cleft palate surgery.
  
  
  METHODS
  After institutional ethics committee approval and parental consent, 50 ASA-1 children of age 1-6 years undergoing palatoplasty were included in this prospective randomized double-blind study. A standardized technique of general anesthesia was used. The surgical site was infiltrated with either 2 mg·kg(-1) of bupivacaine (Group B) or 0.5 mg·kg(-1) of ketamine (Group K). Pain (Children Hospital Eastern Ontario Pain Score), sedation, dysphagia, nausea, vomiting, and sleep pattern were assessed postoperatively up to 24 h.
  
  
  RESULTS
  CHEOPS scores were similar in both the groups up to 12 h but were lower with ketamine compared with bupivacaine at 24 h postoperatively (P = 0.01). Fewer children required rescue analgesics in Group K (28%) than in Group B (64%; P < 0.01). The time to first rescue analgesic and the amount of analgesics used in 24 h were similar in the two groups. Fewer children suffered from dysphagia in Group K (52%) than in Group B (88%; P < 0.01). More children in Group B had disturbed sleep than in Group K at 6 (88% vs 56%; P = 0.012) and 12 h (60% vs 24%; P = 0.01) postoperatively. None of the children had deep sedation, desaturation or respiratory depression.
  
  
  CONCLUSIONS
  Surgical site infiltration with either bupivacaine or ketamine provides adequate analgesia and is devoid of major side effects. Ketamine is superior to bupivacaine in terms of requirement of rescue analgesic, peaceful sleep pattern and early resumption of feeding.
authors: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors: Ajay Kumar
authors: AK
authors: Jha
authors: Neerja
authors: N
authors: Bhardwaj
authors: Sandhya
authors: S
authors: Yaddanapudi
authors: Ramesh Kumar
authors: RK
authors: Sharma
authors: Jai Kumar
authors: JK
authors: Mahajan
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use*; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012890:Sleep / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000778:Anesthetics, Dissociative; D000779:Anesthetics, Local; D007649:Ketamine; D002045:Bupivacaine