title: Ketamine peritonsillar infiltration during tonsillectomy in pediatric patients: An updated meta-analysis.
abstract: OBJECTIVE
  Peri-operative ketamine peritonsillar infiltration in children can reduce the incidence of postoperative nausea and vomiting (PONV), but its postoperative analgesic time is short. A previous meta-analysis in 2011 was inconclusive due to insufficient data. Consequently, we updated the meta-analysis to verify the role of ketamine peritonsillar infiltration for tonsillectomy in pediatric patients.
  
  
  METHODS
  Ten randomized controlled trials with a total of 522 cases were included. Pain intensity was measured by standard modified CHEOPS score.
  
  
  RESULTS
  The pain scores of ketamine group at 30 min and 60 min were significantly lower than placebo group after surgery [weighted mean difference (WMD) -1.20, 95% CI -2.20 to -0.19, P=0.02; WMD -1.71, 95% CI -2.12 to -0.22, P=0.02]. Analgesic requirement in ketamine group were less than placebo group [risk ratio (RR) 0.51, 95% CI 0.26-0.97; P=0.04]. Moreover, the incidence of PONV was lower in ketamine group. (RR 0.73, 95% CI 0.54-0.97; P=0.03). However, there were no differences between these two groups in operation time, anesthesia time, first analgesic time and pain score at 120 min.
  
  
  CONCLUSIONS
  Compared to placebo, ketamine peritonsillar infiltration can relieve postoperative pain within one hour but not at 120 min and reduces analgesic requirement and incidence of PONV. Moreover, there was no difference in the first analgesic time.
authors.affiliation: Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Tong
authors.affiliation: Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
authors.forename: Xi-Bing
authors.initials: XB
authors.lastname: Ding
authors.affiliation: Department of First Clinical Medical College, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
authors.forename: Zhi-Xia
authors.initials: ZX
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China. Electronic address: quanligene@126.com.
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
mesh_terms: D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011184:Postoperative Period; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Ketamine; Meta-analysis; Postoperative pain relief; Tonsillectomy