Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy

Abstract Background This study aimed to observe the effect of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy. Methods Eighty children scheduled for tonsillectomy and adenoidectomy were randomly divided into two groups using a random number table: esketamine group (S-ketamine group, n = 40) and control group (control group, n = 40). Before anesthesia induction, the S-ketamine group received an intravenous injection of esketamine at 0.5 mg/kg, whereas the control group was given the same dose of sodium chloride injection. For the maintenance of anesthesia, the S-ketamine group was treated with propofol of 8–12 mg/kg/h, remifentanil of 0.1–0.4 µg/kg/min, and esketamine of 0.125 mg/kg/h, while the control group was treated with propofol of 8–12 mg/kg/h and remifentanil of 0.1–0.4 µg/kg/min. Both groups were treated with intravenous inhalation combined with general anesthesia. The operation time, recovery time, postanesthesia care unit (PACU) stay time, and adverse reactions within 48 h after operation were observed and recorded. The face, legs, activity, cry, and consolability (FLACC) pain scale score was evaluated at 15 min (T1), 1 h (T2), 6 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) after the operation. The emergence agitation score (pediatric anesthesia emergence delirium [PAED]) was evaluated in 15 min (T1) and 1 h (T2) after the operation. The plasma C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were measured at T0 and T3. Results There were no significant differences in operation time, recovery time, and PACU stay time between the two groups ( p > 0.05). At T1, T2, T3, T4, and T5, the FLACC pain scores of the S-ketamine group were significantly lower than those of the control group ( p < 0.05). The PAED scores at T1 and T2 in the S-ketamine group were significantly lower than those in the control group. Compared with T0, the plasma CRP and IL-6 concentrations at T3 in the two groups were significantly increased ( p < 0.05), but the increase in the S-ketamine group was significantly smaller than that in the control group ( p < 0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups ( p > 0.05). Conclusion Esketamine used in pediatric tonsillectomy and adenoidectomy can effectively reduce postoperative FLACC, PAED score, and levels of inflammatory factors without increasing adverse reactions.