Ketamine peritonsillar infiltration during tonsillectomy in pediatric patients: An updated meta-analysis

Objectives: Pen-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. (C) 2014 Elsevier Ireland Ltd. All rights reserved.