435: Pre-operative Nebulised Ketamine and Acute Paediatric Post Tonsillectomy Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Throat pain is a significant post-operative complication associated with tonsillectomy and can be severe in up to 50% of patients. Post-tonsillectomy pain management in Ghana is usually achieved with analgesics like paracetamol and ibuprofen. Nebulisation can be employed in the peri-operative period especially in children without an intravenous access. Ketamine is an anaesthetic agent with analgesic and sedative properties at sub-anaesthetic doses and can be part of multi modal analgesic strategies.
The aim of this study was to primarily determine the effect of pre-operative nebulised ketamine on post-operative pain and pre-operative sedation and anxiolysis in children scheduled for tonsillectomy.

Methods: A randomised double-blind study in children aged 2 to 7 years.
Children were nebulised with either saline (5mls) or ketamine (1mg/kg diluted to 5mls) preoperatively. Sedation, separation anxiety(PSAS) and the mask acceptance scores(MAS) were documented before surgery. Post-operative FLACC pain scores were taken at 0,1,2,4,6, and 24 hours.
The incidence of post-operative vomiting was assessed within the first 24 hours.
PSAS, sedation, MAS and FLACC scores were summarised as mean and standard deviation, and the mean scores were compared using the student T-test. Categorical data was summarised as frequencies and percentages and comparisons were done using chi-square test.

Results: The proportion of children in the KT group with moderate dynamic pain at 4 hours was higher than those in NS group (36.67% vs. 7.14%, p value = 0.006).
The separation anxiety scores were similar between the two groups(NS 1.50 ± 0.86 vs KT 1.44 ± 0.80, P-value = 0.780).
The average sedation score was similar (NS 2.31 ± 0.47 vs KT 2.44 ± 0.84, P-value = 0.160).
The mask acceptance score was also comparable between the two groups (NS 1.62 ± 0.94 vs KT 1.59 ± 1.01, P-value = 0.930).
The incidence of post-operative vomiting was similar. (NS: 3.6% vs. KT: 3.3% P-value = 1.00).

Conclusions: The static pain scores were not significantly different between the Ketamine and Saline groups. However, children nebulised with ketamine had significantly higher moderate pain 4 hours after surgery compared to the controls.
Pre-operative nebulised ketamine did not result in lower separation anxiety, sedation and mask acceptance scores compared with controls.
The incidence of post-operative vomiting was similar between the ketamine and saline groups.

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Presenting Author: Zan-nairah Napaga Tahiru
Submitting Author: Zan-nairah Tahiru

Senior Author: Robert Djagbletey

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr. Robert Djagbletey: MBCHB, FGCS - University of Ghana Medical School
• Dr. Papa Kobina Gyakye deGraft-Johnson: MBCHB, FGCS - Korle Bu Teaching Hospital
• Dr Ebenezer Owusu Darquah: MBCHB,FGCS. - University of Ghana Medical School
• Mr. Raymond Essuman: Bsc, Msc (Statistics) - University of Ghana Medical School