Pre-emptive analgesia with intravenous ketamine reduces postoperative pain in young patients after appendicectomy: a randomized control study

Thirty-six young patients (12-17 years old) for appendicectomy were randomly allocated to receive ketamine 0.5 mg.kg-1 (K 0.5 group; n = 12), ketamine 1.0 mg.kg-1 (K 1.0 group; n = 12), or lactated Ringer's solution 5 ml (control group; n = 12), which was administered intravenously before incision. After the surgery, all patients received a nonsteroidal anti-inflammatory drug (NSAID) without limitation as requested by the patient. Pain scores at rest and on movement were assessed at 6-10 hr, 24 hr, and 48 hr post-operatively using a visual analogue scale. The frequency at which NSAID was given for postoperative analgesia in the first 48 hr after the surgery was recorded. The patients in the K 0.5 and K 1.0 groups had significantly lower pain scores at rest 6-10 hr postoperatively than the patients in the control group (P < 0.05). Additionally, the patients in the K 1.0 group had a significantly lower pain score on movement 6-10 and 48 hr postoperatively than those in the control group (P < 0.05). The K 0.5 and K 1.0 groups each used significantly less NSAID during the 48-hr postoperative period than the control group (P < 0.05). Intravenous administration of ketamine before incision was associated with decreases in pain at rest 6-10 hr postoperatively and a reduction in NSAID requirement after appendicectomy. Administration of ketamine 1.0 mg.kg-1 prior to incision was superior to administration of 0.5 mg.kg-1 in relief of pain on movement after the surgical procedure.