Analgesic Effect of Intranasal Ketamine for the Management of Post-operative Pain after Strabismus Surgery in Pediatric Patients

Background: Strabismus surgery is a common ophthalmic surgical procedure in children. Post-operative pain is an undesirable post-operative outcome in these patients. Objectives: This study aimed to compare the efficacy of intravenous paracetamol and intranasal (IN) ketamine for management of Post-operative pain in children undergoing strabismus surgery. Methods: Sixty pediatric patients who candidate for strabismus surgery were randomized into two groups: IN ketamine (Group K) and IV paracetamol (Group P). Group K received 0.5 mg/kg (50 mg/ml) IN ketamine and group P received 10 mg/kg IV paracetamol after induction of general anesthesia in all participants. The pain scale, level of sedation, vital signs and adverse effects were recorded at 10, 20, 30 min and 60 min post-operative. Results: The mean age of subjects in group K and group P was 4.8±2.6 and 4.6±2.5 years respectively. The comparison of pain score and sedation scale among two groups identified a statistically significant difference between group K and group P at 10, 20, 30 and 60 min after operation. The post-operative adverse events were not statistically significant between both groups. No patients in group K and 8 cases in group P needed to additional dose of opioid during recovery stay. Dizziness was seen in four of the patients in group K and three of the patients in group P. There was no significant difference or changes in terms of vital signs in either group perioperatively. Conclusion: Our study suggested that IN ketamine has been shown to produce more effective analgesia when compared to IV paracetamol after strabismus surgery.