Serkan TELLİ, Süleyman CAMGÖZ, Merve YAMAN, Ece OKGIL, Nurullah TÜRE
Journal of Health Sciences and Medicine - 2026;9(4):1140-1147
Aims: Postoperative pain remains a major concern after pediatric tonsillectomy, and the limitations of systemic analgesics highlight the need for safer local alternatives. This retrospective study examined whether intraoperative tonsillar irrigation with ketamine and/or dexmedetomidine was associated with lower postoperative pain scores. Methods: This single-center retrospective cohort study reviewed the records of 80 children (4-10 years, ASA I-II) who underwent tonsillectomy between April and October 2024. Patients were classified by the irrigation solution recorded in the anesthesia notes into four groups; saline, ketamine, dexmedetomidine, and combination. Oucher and modified Hannallah pain scores at 30 minutes, 60 minutes, 4 hours, and 24 hours postoperatively, additional analgesic use, and hemodynamic parameters were extracted. Results: Demographic and perioperative characteristics were similar across groups (all p>0.05). At 30 minutes, modified Hannallah scores were significantly lower in the combination than the saline group (Bonferroni-adjusted post-hoc), whereas the OUCHER omnibus did not reach significance. At 4 and 24 hours, dexmedetomidine-containing regimens showed lower pain scores on both scales, with the lowest medians in the dexmedetomidine and combination groups. Rescue analgesic requirement at 30 minutes was highest in the ketamine and saline groups, lower in dexmedetomidine, and absent in combination, with no significant differences thereafter. No clinically significant adverse events were documented. Conclusion: Dexmedetomidine-containing intraoperative tonsillar irrigation was associated with lower early postoperative pain scores and reduced early rescue analgesic requirements after pediatric tonsillectomy; adding ketamine to dexmedetomidine did not confer a clear additional benefit over dexmedetomidine alone. This injection-free approach should be confirmed in prospective randomized controlled trials before broader clinical adoption.
