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Background: Controlling pain and anxiety in children is important and at the same time more difficult compared to adults. In the present study, an attempt has been made to reduce the overall dose and, as a result, the complications caused by ketamine by adding local anesthesia with lidocaine after analgesia and intravenous sedation with ketamine.
Methods: A double-blind, randomized clinical trial was carried out at the emergency ward of Khatam Al-Anbia Hospital, Zahedan, between June 2018 and March 2019. A total of 60 children with finger injuries with the age range of 1 to 5 years were divided into two groups of 30 people by random block method. The control group was injected with only intravenous ketamine at a dose of 1.5 mg/kg, and the intervention group was injected with local anesthesia with lidocaine after the injection of intravenous ketamine. Data analysis was performed using SPSS software (version 21) with descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (Student’s t-test, chi-square test, and Mann-Whitney U test) at a significance level of P<0.05.
Results: The recovery time in the intervention group (29.27±9.48 minutes) was significantly less than the control group (35.90±10.59 minutes) (P=0.01). No significant cardiopulmonary complications occurred in the two groups. The incidence of vomiting (P=0.08) and the drop in blood oxygen saturation percentage (P=0.3) were higher in the control group than in the intervention group, but it was not statistically significant. Adding local anesthesia to intravenous injection of ketamine significantly delays the duration of the second repetition of ketamine injection (P=0.01), But it did not affect the time of the first and third repetition of ketamine dose.
Conclusion: The findings of this study indicate that the intervention group required significantly fewer ketamine doses than the control group. Notably, adjunctive lidocaine local anesthesia was associated with shorter recovery times and prolonged intervals before second-dose ketamine administration, while no such effects were observed for the first or third doses. These results imply that lidocaine supplementation could optimize intravenous ketamine therapy by accelerating recovery and reducing subsequent dose requirements, though additional research is needed to validate these observations.
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