The interest of ketamine as an adjuvant to fentanyl in post-tonsillectomy analgesia in children: a randomized controlled trial.

Introduction: tonsillectomy is the most commonly performed surgery in children. It is a painful surgery, which is often an ordeal for both children and their parents. The study aimed to evaluate the effects of ketamine used instead of or as an adjuvant to fentanyl on early postoperative pain scores in children undergoing tonsillectomy. Methods: we conducted a double-blind prospective randomized study including 60 children, aged between 2 and 7 years, scheduled to undergo adenotonsillectomy. Patients were randomly assigned to one of three groups: group G1 received 2 μg/kg of fentanyl, group G2 received 0.5 mg/kg of ketamine and group G3 received an association of fentanyl 1μg/kg and 0.25 mg/kg of ketamine. We recorded postoperative analgesic requirements and side effects. The pain was assessed in the post-anesthesia care unit (PACU) by the face, legs, activity, cry, and controllability (FLACC) pain scale. We evaluated the requirement for additional analgesics, postoperative nausea, and vomiting. Results: sixty children were included. Twenty patients were randomly assigned to one of three groups. Better control of pain was noted in group G3 ( Median FLACC scale G3=0 Inter quartile range (IQR)=-1 - 1), with a significant difference at 30 min compared to both groups G1 (median FLACC scale G1=3 [IQR=-1 - 7]; p=0,008) and G2 (median FLACC scale G2=1 [IQR=-2 - 4]; p=0.036). The need for additional analgesia and side effects in the PACU were comparable for the three groups. Conclusion: ketamine associated with fentanyl provides satisfactory early analgesia and can even replace fentanyl during tonsillectomy.