Esketamine vs fentanyl for pediatric tonsillectomy pain shows comparable FLACC scores

PURPOSE: To investigate the effects of esketamine compared with fentanyl on postoperative pain, sedation, and hemodynamics in children undergoing tonsillectomy under general anesthesia with endotracheal intubation. METHODS: This randomized, double-blind, controlled trial included 54 children scheduled for plasma tonsillectomy, randomly allocated into group E (esketamine 0.5 mg·kg) and group C (fentanyl 4 μg·kg) at anesthesia induction, with identical anesthesia protocols otherwise. Primary outcome was FLACC pain score at 2 hours postoperatively. Secondary outcomes included FLACC scores at 8 and 24 hours, Ramsay Sedation Scale scores at 5, 10, 15 minutes after extubation, hemodynamic variables, anesthesia and surgery duration, emergence and extubation time. Safety outcomes were adverse events within 48 hours postoperatively. RESULTS: FLACC scores at 2, 8, and 24 hours were comparable between groups ( > 0.05). Mean arterial pressure and heart rate were significantly higher in group E after induction and at the beginning of surgery ( < 0.05). Sedation scores, anesthesia and surgery duration, emergence and extubation time, anesthetic consumption, and adverse events within 48 hours showed no significant differences between groups (all > 0.05). CONCLUSION: Esketamine showed no significant difference in pain scores but more stable intraoperative hemodynamics compared with fentanyl in pediatric tonsillectomy using plasma energy.