• P Dix, S Martindale, and P A Stoddart.
• Department of Anaesthesia, RD & E Hospital (W), Exeter, UK. philippa@dixracwil.demon.co.uk
• Paediatr Anaesth. 2003 Jun 1; 13 (5): 422-6.

BackgroundKetamine has an opioid sparing effect following surgery in adults. This study investigated whether a similar effect is seen following appendicectomy in paediatric patients.MethodsSeventy-five ASA 1 or 2 children aged 7-16 years were recruited, and randomly allocated to one of three groups. Following a standard anaesthetic for appendicectomy, all were prescribed patient controlled analgesia (PCA) morphine with paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDS) as required for postoperative analgesia. In addition the control group received a saline infusion postoperatively, the ketamine bolus group received 500 micro g.kg-1 intravenous (i.v.) ketamine preincision and a saline infusion postoperatively, and the ketamine infusion group received 500 micro g.kg-1 i.v. ketamine preincision and a ketamine infusion at 4 micro g.kg-1 min-1 postoperatively. Morphine consumption, rescue analgesia requirement and side-effects were recorded postoperatively.ResultsThere was no difference in morphine consumption between the groups. The ketamine infusion group required more doses of rescue analgesia and reported more side-effects than the control group. Five patients, all in the ketamine infusion group, reported hallucinations.ConclusionsIn this paediatric population intravenous ketamine did not have a morphine sparing effect. The increased incidence of side-effects, especially hallucinations, reported by patients given a ketamine infusion may limit the further use of postoperative ketamine in children.

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