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Patient-controlled analgesia with ketorolac in pediatric surgery
M Moreno1, F J Castejón, M A Palacio
1Depto de Fisiología, Facultad de Farmacia, Universidad de Granada, Spain.
Insights
Patient-controlled analgesia (PCA) using ketorolac provided superior pain management efficiency compared to standard methods in children aged 6-14 undergoing surgery. Both techniques effectively reduced pain, but PCA demonstrated higher overall efficiency.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Effective postoperative pain management is crucial for pediatric surgical recovery.
- Patient-controlled analgesia (PCA) offers a tailored approach to pain relief.
- Ketorolac is a commonly used non-steroidal anti-inflammatory drug for moderate pain.
Purpose of the Study:
- To quantify and compare the analgesic efficacy of intravenous ketorolac via patient-controlled analgesia (PCA) versus conventional administration in children (6-14 years) post-surgery.
- To evaluate pain intensity and analgesic effectiveness using the Hannallah behavioral scale and pain intensity difference (PID) scores.
Main Methods:
- A double-blind, randomized controlled trial was conducted with two groups: intravenous PCA with "bolus on demand" and a Standard group receiving conventional ketorolac I.V. (0.5 mg/kg/6 hours).
- Pain was assessed using the Hannallah behavioral scale and summed pain intensity scores.
- Analgesic efficiency was measured by the pain intensity difference (PID) score.
Main Results:
- Both PCA and standard ketorolac groups showed significant pain reduction over time within 6 hours post-surgery.
- No significant differences in pain intensity or analgesic effect were found between the PCA and standard groups at 1 and 6 hours.
- The accumulated pain score showed a significant reduction at 6 hours in both groups, with no inter-group differences.
Conclusions:
- Both patient-controlled analgesia (PCA) and standard ketorolac administration are effective for managing postoperative pain in children aged 6-14.
- While both methods demonstrated comparable pain relief, the patient-controlled analgesia technique showed a trend towards higher overall efficiency in this pediatric surgical population.
Abstract:
Our aim was to quantify the analgesic efficiency of the patient-controlled analgesia technique (PCA), using ketorolac, in children aged 6-14 undergoing a surgical intervention. We carried out a double-blind test with two randomly selected groups: the PCA group comprising patients submitted to intravenous PCA, with "bolus on demand" and the Standard group, with conventional analgesia dispensed with ketorolac I.V. (0.5 mg/kg/6 hours). Evaluation of pain experienced was performed using the Hannallah behavioural scale and quantification of the summing of pain intensity. Analgesic efficiency was determined by the pain intensity difference (PID) score. Evaluation of pain experienced during hour 1 reveals a marked reduction with time for each group; no inter-group differences were found. At hour 6 there were neither intra-group nor inter-group differences. The accumulated pain score revealed a significant reduction in hour 6, with no differences between the two groups. Evaluation of the analgesic effect revealed no differences, either intra-group or intergroup, during the experimental period. The sum of the PIDs revealed significant differences in the standard group between the values for hours 1 and 6. Under the experimental conditions described, both techniques were equally effective for pain treatment, but the efficiency was higher for the PCA group.