Ketamine Versus Magnesium as Analgesic Adjuvants in Pediatric Adenotonsillectomy
Status:
Not yet recruiting
Trial end date:
2023-03-01
Target enrollment:
Participant gender:
Summary
Adeno-tonsillectomy is one of the most common surgeries in children. The most common
complication associated is postoperative pain. If not well controlled, especially in
preschool children, it can lead to a longer recovery period, delayed discharge, and
nutritional deficiencies resulting in dehydration. These factors will increase
hospitalization period and the need for intravenous fluids.
For this purpose, a large number of studies has been designed to evaluate the analgesic
effects of various drugs during the perioperative period. Opioids are associated with
sedation and respiratory depression, NSAIDs increase the risk of reoperation for bleeding
while local anesthetics may cause vasoconstriction of the operation site.
For several years, N-methyl-D-aspartate (NMDA) receptors antagonists, such as ketamine and
magnesium, have been used successfully to decrease postoperative pain and analgesic
requirements in adult patients undergoing a number of different procedures. Ketamine reduces
the needed analgesia after tonsillectomy. Most studies have shown that ketamine
administration has no side effects such as hemodynamic, respiratory complications and airway
problems.
Magnesium is a physiological antagonist of the NMDA receptor ion channel that plays a key
role in central sensitization. Many studies have investigated the effect of magnesium
sulphate on postoperative pain and opioid consumption. However, results of those studies were
variable. Whereas most studies describe the reduction of postoperative analgesic requirements
after magnesium sulfate, a few studies show insignificant beneficial effects.
A previous study evaluated the effect of low dose ketamine (0.15 mg/kg) and magnesium sulfate
(30 mg/kg) on post tonsillectomy pain in children, which did not demonstrate a decrease in
pain or analgesic consumption in children undergoing tonsillectomy. In this study, the
investigators will increase the dose of ketamine to (0.5 mg/kg) and magnesium sulfate to (40
mg/kg) to evaluate their effect on postoperative pain in pediatric patients undergoing
adeno-tonsillectomy.