Clinical pharmacy intervention post tonsillectomy: a randomized control trial

Back ground Pain control in pediatric patients undergoing tonsillectomy remains a dilemma. Tramadol and ketamine are reported to be an effective analgesic. Aim of the study To evaluate the effect of peritonsillar infiltration of tramadol in combination with ketamine versus peritonsillar infiltration of tramadol posttonsillectomy. Setting Specialty hospital in Jordan. Method Sixty children, aged 7–12 years, selected for tonsillectomy were enrolled in the study. We divided the patients into two groups 30 of each, Group I: received peritonsillar saline and peritonsillar infiltration of tramadol 2 mg/kg, Group II: received peritonsillar infiltration of ketamine 1.0 mg/kg added to peritonsillar tramadol 2 mg/kg. Main outcome measure Hemodynamic stability, pain scale, first request of analgesia, total analgesics consumption and post-operative nausea and vomiting (PONV) side effects were recorded 24 h after surgery. Results The analysis of data showed that Group II had significantly lower face pain scale, longer time for first request of analgesia, and better hemodynamic stability than GI (p < 0.001). On the other hand the total analgesics requirements, time of surgery, and PONV showed no significant differences between the two groups. Conclusion Combined use of peritonsillar infiltration of ketamine 1.0 mg/kg with tramadol 2 mg/kg provided prolong analgesic effects, less pain with no side effect, and better hemodynamic stability compared with using tramadol alone in patients undergoing tonsillectomy.