Effects of Intranasal dexmedetomidine and esketamine for premedication on postoperative pain after tonsillectomy and adenoidectomy in children: a randomized clinical trial.
Jun-Wei Qi, Chuang Li, Xin-Yuan Qiu, Xin-Ge Wen, Hua Yin, Qing-Ling Meng, Li Li, Qian Zhang, Yue-Ying Zhang
BMC Anesthesiology July 1, 2025 DOI: 10.1186/s12871-025-03203-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 173 |
| Population | Children undergoing tonsillectomy and adenoidectomy |
| Interventions | Dexmedetomidine Esketamine |
| Dose | dexmedetomidine 1.0 μg·kg-1 and esketamine 0.6 mg·kg-1 |
| Duration | 30 minutes before surgery, with follow-up to 24 hours after surgery |
| Topics | Esketamine |
| Keywords | Postoperative analgesia Paediatric anesthesia: children Paediatric patients Tonsillectomy/adenoidectomy Distress Pain scores Safer More comfortable recovery Emergence delirium incidence The combination This approach Intranasal dexmedetomidine Intranasal esketamine |
| Citations | 2 |
| Key findings | Intranasal dexmedetomidine combined with esketamine reduced postoperative pain and emergence delirium in children compared with saline or dexmedetomidine alone. |
Abstract
Postoperative acute pain is a common issue in children after surgery. Our study aimed to investigate whether preoperative use of a dexmedetomidine-esketamine combination could reduce postoperative pain in children undergoing tonsillectomy and adenoidectomy and reduce side effects, such as bradycardia, hypotension or emergence delirium. In this double-blind, randomised controlled clinical trial, 180 children were randomly assigned to 3 groups. 30 min before surgery, the control group received 0.9% saline intranasally (Group C), the dexmedetomidine group received intranasal dexmedetomidine at 2.0 μg·kg-1 (Group D), and the combination group received intranasal dexmedetomidine at 1.0 μg·kg-1 and esketamine at 0.6 mg·kg-1 (Group DS). The primary outcome was the area under the curve (AUC) of the pain score within 24 h after surgery. Secondary outcomes included the incidence of emergence delirium (ED), pain scores after hospital discharge, and incidence of perioperative adverse events. A total of 173 children completed the study. The AUC of the pain score at rest within 24 h after surgery was 37.25 (20.25-51.75) in Group C, which was higher than those in Groups D (19.25 [12.50-39.13], P < 0.001) and DS (9.50 [9.00-16.25], P < 0.001). Compared with the control group, the DS group had a lower incidence of ED (12.3% vs. 44.8%, P = 0.001). Heart rates (HRs) in groups DS (P < 0.001) and C (P < 0.001) were higher than those in the dexmedetomidine group at all time points. No serious adverse events occurred. Intranasal dexmedetomidine combined with esketamine for premedication was associated with reduced postoperative pain in children. It can also prevent ED and had fewer side effects.
Comparable studies
Other randomized controlled trials on esketamine, most cited first.
Citations in the library
Cites 3
- Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) CNS Neuroscience & Therapeutics April 10, 2013
- Pharmacokinetics and Bioavailability of Inhaled Esketamine in Healthy Volunteers Anesthesiology July 30, 2017
- Esketamine accelerates emergence from isoflurane general anaesthesia by activating the paraventricular thalamus glutamatergic neurones in mice. British Journal of Anaesthesia December 1, 2023