RESUMO
To evaluate the efficacy of preoperative intravenous or peritonsillar infiltration of ketamine for postoperative pain control in children following adenotonsillectomy. Patients and 78 children between 5 and 18 years of age who were scheduled for elective adenotonsillectomy were randomly assigned to four groups: group 1 [n=19] received intravenous ketamine [0.5 mg/kg], group 2 [n=21] intravenous normal saline, group 3 [n=19] ketamine [0.5 mg/kg] injected through the tonsillar capsule, and group 4 [n=19] normal saline injected in the same location. The incidence of postoperative pain and vomiting as well as the severity of postoperative pain were compared between study groups during the 6-hour postoperative period using a visual analog scale [VAS] at rest, upon swallowing saliva, drinking liquids and eating ice cream. There were no demographic differences between the four groups. The incidence of postoperative pain was significantly lower in groups 1 [7 [36.8%] vs. 10 [47.6%]; p=0.032] and 3 [5 [31.5%] vs. 12 [63.2%]; p=0.001] compared with their controls. The amount [in milligrams] of pethidine and metoclopramide used for pain and nausea control was significantly lower in groups 1 [12.5 +/- 5.3 vs. 19.6 +/- 9.6 mg, p=0.038, and 2.9 +/- 1.1 vs. 4.6 +/- 2.6 mg, p=0.042, respectively] and 3 [8.6 +/- 3.1 vs. 21.6 +/- 8.4 mg, p<0.001, and 1.6 +/- 0.9 vs. 5.3 +/- 3.2 mg, p=0.002, respectively] compared with their controls. These values were also higher in group 1 compared with group 3. The VAS scores on swallowing saliva [3.9 +/- 2.7 vs. 2.7 +/- 1.2; p=0.018], on drinking liquids [3.7 +/- 2.6 vs. 2.8 +/- 1.6; p=0.013] and on eating ice-cream [4.3 +/- 2.4 vs. 2.8 +/- 1.5; p=0.001] were also significantly higher in group 1 compared with group 3. Conclusions: Our results show that peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity, need for analgesics and need for antiemetics. Thus, peritonsillar infiltration of ketamine is suggested for postoperative pain control in those undergoing adenotonsillectomy
RESUMO
To evaluate the effect of gabapentin on the incidence and severity of postoperative nausea and vomiting [PONV] after open cholecystectomy. A total of 90 patients scheduled for elective open cholecystectomy were randomly assigned to either a gabapentin group [600 mg, 2 h before surgery] or a placebo group. For the analysis, 1 patient was excluded from the gabapentin group and 2 patients from the placebo group. A standard technique was used for anesthesia. Pethidine and metoclopramide were used for postoperative management of pain and nausea/vomiting, respectively. The prevalence of PONV, its severity [measured on visual analogue scale, VAS], and total pethidine and metoclopramide use in the first 24 h after the operation were recorded. There were no demographic differences between the two groups. Of the 44 patients given gabapentin, 16 [36.6%] and 28 of 43 [65.2%] placebo patients developed PONV; the difference was statistically significant [p = 0.02]. However, there was no difference in the severity of PONV between the gabapentin and placebo groups [p = 0.12]. Gabapentin patients used less pethidine [28.33 +/- 129 mg] and metoclopramide [6.0 +/- 6.3 mg] than the placebo group [35.1 +/- 15.1 and 9.33 +/- 7.1 mg, respectively]. The differences were statistically significant [pethidine: p = 0.002, metoclopramide: p = 0.033]. However, gabapentin did not reduce postoperative pain significantly [p = 0.096]. Our data show that gabapentin not only reduced PONV after open cholecystectomy, but also reduced the need for additional postoperative analgesics