Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy.

In children undergoing tonsillectomy and adenoidectomy, adding esketamine during anesthesia reduced postoperative pain and emergence agitation without increasing side effects. Eighty children were randomly assigned to receive esketamine or a control. Pain scores (FLACC scale) were lower in the esketamine group at all measured times from 15 minutes to 24 hours after surgery (e.g., 2.4 vs. 3.4 at 15 minutes). Emergence agitation scores were also lower. Blood markers of inflammation (C-reactive protein and interleukin-6) rose less in the esketamine group. Recovery times and adverse reactions were similar between groups.

Study at a glance

Abstract

This study aimed to observe the effect of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy. Eighty children scheduled for tonsillectomy and adenoidectomy were randomly divided into two groups using a random number table: an esketamine group (S-ketamine group, N.=40) and a control group (control group, N.=40). The primary outcome was the postoperative pain score, measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale score. Secondary outcomes include the emergence agitation score (Pediatric Anesthesia Emergence Delirium [PAED]), the operation time, recovery time, postanesthesia care unit (PACU) stay time, adverse reactions within 48 h after operation, and the plasma C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations. At T1, T2, T3, T4, and T5, the FLACC pain scores of the S-ketamine group were significantly lower than those of the control group (15 min: 2.4±0.7 vs. 3.4±0.8, P<0.01; 1 h: 1.7±0.6 vs. 2.2±0.7, P<0.01; 6 h: 1.5±0.6 vs. 2.0±0.5, P<0.01; 12 h: 1.5±0.6 vs. 1.8±0.7, P<0.05; 24 h: 1.4±0.6 vs. 1.7±0.6, P<0.05). The PAED scores at T1 and T2 in the S-ketamine group were significantly lower than those in the control group (15 min: 4.0±0.9 vs. 6.4±1.3, P<0.01; 1 h: 1.7±0.6 vs. 2.1±0.5, P<0.01). Compared with T0, the plasma CRP and IL-6 concentrations at T3 in the two groups were significantly increased (P<0.01), but the increase in the S-ketamine group was significantly smaller than that in the control group at T3 (IL-6: 111.8±19.2 vs. 145.8±22.5, P<0.01; CRP: 1.2±0.5 vs. 1.5±0.5, P<0.01). The other outcomes were similar between the two groups. Esketamine used in pediatric tonsillectomy and adenoidectomy can effectively reduce postoperative FLACC, PAED score, and levels of inflammatory factors without increasing adverse reactions.