title: Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis.
abstract: OBJECTIVE
  The goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.
  
  
  METHODS
  Two authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0-24 hours after leaving the operation room were included in the analysis.
  
  
  RESULTS
  The pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.
  
  
  CONCLUSIONS
  Preoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.
authors: Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea.
authors: Hye Kyung
authors: HK
authors: Cho
authors: Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea.
authors: Kyu Won
authors: KW
authors: Kim
authors: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Yeon Min
authors: YM
authors: Jeong
authors: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Ho Seok
authors: HS
authors: Lee
authors: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Yeon Ji
authors: YJ
authors: Lee
authors: Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Se Hwan
authors: SH
authors: Hwang
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology*; D011300:Preoperative Care; D014068:Tonsillectomy / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D007649:Ketamine