Comparison of ketamine and fentanyl in pediatric tonsillectomy: Impact on pain control and emergence delirium.

Background: Effective pain control following tonsillectomy in children remains challenging. Traditionally, opioids such as fentanyl have been used for pain control, but its adverse effect profile makes it a less ideal option for children, particularly those with obstructive sleep apnea. The curent study investigates the perioperative effects of ketamine on postoperative pain and delirium in children. Methods: In this prospective trials, patients 3-8 years of age were randomized to receive either fentanyl or ketamine for pain management. Pain was assessed using the face, legs, activity, crying, consolability (FLACC) scale, and emergence delirium was evaluated with the pediatric anesthesia emergence delirium (PAED) scale. Postoperative outcomes, including recovery time and analgesic requirements, were also recorded. Results: The study cohort include 59 pediatric patients. The ketamine group exhibited higher pain scores in the first 15 min post-surgery compared to the fentanyl group. However, pain scores between the two groups were comparable by 30 min. The incidence of emergence delirium was higher with ketamine than fentanul (19.35% versus 3.57%). The groups had similar recovery and post-anesthesia care unit (PACU) times, as well as supplemental analgesia requirements. Conclusion: Although ketamine demonstrated delayed pain relief and a higher incidence of emergence delirium, it showed potential as part of a multimodal analgesic approach. The combination of fentanyl and ketamine may optimize pain management in pediatric tonsillectomy, reducing opioid use while minimizing adverse effects. Further studies are needed to refine dosing strategies and assess long-term outcomes.