Discussion
cleft palate, postoperative pain, pain, respiratory distress, nausea, vomiting
INFILTRATE, THYROID, INFILTRATION, INFILTRATING
Acute pain is one of the most common complaints after surgery. Thyroid surgery is known to be responsible for mild to moderate postoperative pain during the first 24 hours, with a mean VAS score of 6.9 (±1.7).
The attempted locoregional anesthetic approaches to reduce post-thyroidectomy pain have included mainly bilateral superficial cervical plexus block and local wound infiltration with a local anesthetic agent.
Wound infiltration with a local anesthetic agent is a simple and safe procedure to reduce postoperative pain with fewer side effects in comparison with cervical plexus block.
Diclofenac has also been reported as an effective molecule to infiltrate the wound prior to surgery compared to Bupivacaine in reducing postoperative pain.
Ketamine also belongs to the molecules whose local wound analgesic effect has been studied. The local ketamine analgesic effect is related to different mechanisms: blocking sodium, calcium, and potassium channels, as well as binding to opioid, cholinergic, D2, and 5-HTE receptors and monoamine transporters.
In our study, ketamine (2 mg/kg) was injected into the wound after skin closure. It was associated with a significant reduction in VAS scores during swallowing compared to the saline solution group in PACU at 0, 10, and 20 minutes. In a prospective, controlled, double-blind, randomized study, Abd EL-Rahman
We also demonstrated that local injection of ketamine significantly reduced the average morphine requirement compared to the saline solution group. The use of opioids can be associated with severe side effects such as nausea, vomiting, and respiratory distress.
Kim
The use of ketamine as a local wound infiltration agent was studied more frequently in oral, tonsillar, and abdominal surgeries. In their meta-analysis, Cho
Infiltrating the surgical site using ketamine in pediatric patients undergoing cleft palate surgery was superior to Bupivacaine with respect to analgesic requirements, quality of sleep after surgery, and speed of recovery.
Regarding abdominal surgeries, Honarmad
In a randomized double-blind study, patients undergoing cholecystectomy who received subcutaneous ketamine infiltration at a dose of 2 mg/kg or intravenous ketamine at a dose of 1 mg/kg 15 minutes before surgical incision reported enhanced analgesia for 24 hours after surgery.
Our study has several limitations. First, thyroid surgeries were performed by different surgeons. Second, we did not consider the size of the resected thyroid gland which can reflect the extent of surgery and influence postoperative pain.