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The effect of adding ketamine to bupivacaine in greater palatine nerve block in platoplasty

Background Greater palatine nerve block anesthetizes the posterior part of the hard palate and its overlying soft tissue. It is performed for pain relief in children undergoing cleft palate surgery. This study was conducted to compare the efficacy and the duration of this block using the local anesthetic bupivacaine 0.25% alone with that of ketamine 0.5 mg/kg plus bupivacaine 0.25%. Patients and methods After institutional ethical committee approval and parental consent were obtained, 40 ASA I, II children aged 1-6 years undergoing palatoplasty were enrolled in this prospective randomized double-blind study. A standardized technique of general anesthesia was used, and then patients were classified into two groups: in group B (n = 20), the greater palatine nerve block was performed using 0.5 ml bupivacaine 0.25% alone; and in group K (n = 20), the block was performed using ketamine 0.5 mg/kg added to bupivacaine 0.25%. The heart rate, the systolic blood pressure, the pain score, the time to rescue analgesics, and the total amount of analgesics used in 24 h were assessed. Results Group KB had a significantly longer time to first rescue analgesia (8.62 ± 0.5 vs. 4.25 ± 1.1 h) and significantly lower doses of rectal diclofenac (0, 0, 0 vs. 0, 0, 12.5 mg) than group B. The Children′s Hospital Eastern Ontario Pain Scale pain scale was significantly lower in group BK than in group B (P < 0.05) at 4, 8, 12, 18, and 24 h postoperatively. There was a significant difference between the groups in dysphagia to solid and sleep disturbance at 6 and 12 h. Conclusion Addition of ketamine to bupivacaine in greater palatine nerve block increased the quality and the duration of analgesia, and also decreased the total dose of postoperative analgesic requirement in children undergoing cleft palate repair surgery.