ABSTRACT
Introduction: Tonsillectomy is associated with significant pain and post-operative pain control is often unsatisfactory. This study sought to evaluate the effect of peritonsillar infiltration of tramadol-ketamine combination, tramadol alone and ketamine alone on post-tonsillectomy pain in children. Patients and Methods: A randomized double-blinded interventional study involving 90 patients aged 3-15 years of American society of anesthesiologists I or II physical status scheduled for elective adenoidectomy, tonsillectomy or adenotonsillectomy at JUTH was conducted. Patients were randomized into one of three groups: group I received tramadol 2mg/kg, group II received ketamine 1mg/kg plus tramadol 2mg/kg and group III received ketamine 1mg/kg only all made up to 2mls with normal saline and 1ml given per tonsillar bed. All patients had standard general anaesthesia with endotracheal intubation and monitoring. Data was analyzed using Epi-info version 7.1.5 with p £ 0.05. Result: The analysis of data showed that the mean ages of the participants in group I, II and III were 5.70±2.00, 5.69±3.22 and 4.47±2.01 years respectively (p-value=0.091). Group II had significantly lower pain scores, longer time to first request of analgesia, earlier oral intake and discharge from the hospital compared to the group that received either tramadol or ketamine alone. Minimal side effects were noted across all the groups in the study. Conclusion: Peri-tonsillar infiltration of tramadol-ketamine combination immediately after tonsillectomy (but before extubation of patients) significantly decreased post-tonsillectomy pain without increasing the incidence of side effects compared to tramadol or ketamine alone in children undergoing adenotonsillectomy.
ABSTRACT
Background: A patient is required to be fully relaxed and airway reflexes should be adequately suppressed to allow for smooth insertion of a laryngeal mask airway (LMA).Propofol and a variety of other induction agents and their combinations have been tried to ease its insertion. The use of cheaper alternatives in our environment is highly desirable. Aims and objectives: To compare the ease of insertion of LMA in patients given propofol alone versus thiopentone with lignocaine, as well as assessing the cost effectiveness of these agents in our hospital setting. Methods: This is arandomised single blind prospectivestudy carried out in a Public Tertiary Academic Health Institution. Sixty-four ASA I and II patients equally randomized into 2 groups scheduled for short (not lasting more than one hour) elective gynaecological, orthopaedic, urological and general surgical procedures were recruited into this study. Patients were premedicated with 1g.kg-1 fentanyl intravenously and pre-oxygenated for five minutes. This was followed by an induction dose of either 2.5mg.kg-1propofol (group A) or a sequence of 2mg.kg-1 lignocaine and 5mg.kg-1thiopentone (group B) given by a trained assistant. With the patients in the sniffing position, LMA insertion was attempted immediately after induction of anaesthesia by the anaesthetist (researcher) who observed the ease of LMA insertion using presence or absence of adverse airway responses to LMA insertion such as coughing, gagging, laryngospasm, head and limb movement or inadequate jaw relaxation. These responses were graded as; no response, mild response, moderate response and severe response. Overall assessment of the ease of LMA insertion was then done combining these graded adverse airway responses as; excellent if there were no adverse airway responses, good if responses were mild, satisfactory if responses were moderate and poor if responses were severe with additional anaesthetic required to allow LMA insertion.Results: The average age in group A was 36.5±14 whereas in group B it was 38.7±05 with the p=0.493.There were 22 (56.4%) male patients in group A compared to 17 (43.6%) male patients in group B with p=0.528; whereas, there were 10 (40.0%) female patients in group A compared to 15 (60.0%) female patients in group B with p=0.326. Excellent LMA insertion were observed in 28 (87.5%) patients in group A compared to 27 (84.4%) patients in group B (P= 0.893); Good LMA insertion in 2 (6.3%) patients in group A compared to 1 (3.1%) patient in group B (p= 0.564); Satisfactory in 2 (6.3%) patients in group A compared to 4 (12.5%) patients in group B (p= 0.655).Conclusion: Thiopentone together with Lignocaine provided optimum conditions for laryngeal mask airway insertion comparable to that provided by propofol alone
