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Safety of ketorolac in the pediatric population after ureteroneocystostomy
R D Chauhan1, C B Idom, H N Noe
1Department of Urology, University of Tennessee, Memphis, Tennessee, USA.
Insights
Ketorolac is safe for pediatric postoperative pain management after ureteroneocystostomy, showing no significant impact on creatinine, hematocrit, or complications. This supports its use as a standard protocol for improved recovery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pharmacology
Background:
- Ketorolac offers effective postoperative pain relief in children undergoing ureteroneocystostomy, potentially reducing hospital stays.
- Concerns exist regarding ketorolac's potential for severe side effects like bleeding and renal insufficiency in pediatric patients.
- Limited data exists on ketorolac's safety profile, specifically concerning creatinine, hematocrit levels, and complication rates in this population.
Purpose of the Study:
- To evaluate the safety and efficacy of ketorolac as a postoperative analgesic in children following ureteroneocystostomy.
- To assess the impact of ketorolac on renal function (creatinine) and blood loss (hematocrit) compared to traditional narcotic analgesics.
- To determine the incidence of complications associated with ketorolac use in this pediatric surgical context.
Main Methods:
- A retrospective review of 118 pediatric patients who underwent ureteroneocystostomy over 18 months.
- Patients were divided into two groups: one receiving caudal anesthetic and narcotic analgesics, the other receiving caudal anesthetic and ketorolac postoperatively.
- Data collected included patient demographics, procedure type, preoperative and postoperative creatinine and hematocrit levels, and complication occurrences.
Main Results:
- No statistically significant differences were observed in postoperative creatinine or hematocrit levels between the ketorolac and control groups.
- One patient in each group experienced a postoperative increase in creatinine; no major complications or allergic reactions were reported with ketorolac.
- Minor complications, such as ileus and bladder spasms, were comparable between the two treatment groups.
Conclusions:
- Postoperative administration of ketorolac following ureteroneocystostomy in children did not lead to significant increases in creatinine, decreases in hematocrit, or overall complications.
- The safety profile observed in this study supports the use of ketorolac.
- Based on these findings, ketorolac is utilized as a standard postoperative protocol at the institution to manage pain and potentially shorten hospital stays.
Purpose:
Ketorolac has been used to provide effective postoperative analgesia in children and decreases hospitalization for pediatric patients undergoing ureteroneocystostomy. However, it can cause severe side effects, including increased bleeding and renal insufficiency, which can be devastating in a child. Little has been reported on the safety of ketorolac by evaluating creatinine, hematocrit and complications.
Materials And Methods:
An institutional retrospective review was performed during an 18-month period in which 118 patients underwent ureteroneocystostomy. One group containing 50 patients received caudal anesthetic preoperatively and narcotic analgesics postoperatively, while another 68 received caudal anesthetic preoperatively and ketorolac postoperatively. Patient ages, type of procedure, preoperative and postoperative creatinine and hematocrit, and complications were noted in each cohort.
Results:
Average patient age of the control analgesic and ketorolac groups was 5.3 years (range 1 to 17) and 5.5 (1 to 12), respectively. There was no statistical difference between postoperative creatinine (0.68 and 0.65 mg./dl.) and hematocrit (33% and 34%) between the groups. One patient in each group had increased creatinine postoperatively. Minor complications, for example ileus and bladder spasms, were equivalent in both groups. No patient receiving ketorolac had any allergic or hypersensitivity reaction to the medication, and no major complications were reported.
Conclusions:
Ketorolac given after ureteroneocystostomy did not cause a significant decrease in hematocrit, increase in creatinine or overall complications. Because of the safety of ketorolac in our series, and ability to decrease hospital stay and narcotic requirements in children as reported previously, it is used as standard postoperative protocol after ureteroneocystostomy at our institution.
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