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Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy
M F Watcha1, M Ramirez-Ruiz, P F White
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Preoperative ketorolac effectively reduced postoperative pain in children undergoing myringotomy, unlike acetaminophen. This study highlights ketorolac as a superior choice for pediatric pain management after this common surgical procedure.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Prophylactic analgesics can reduce intraoperative anesthetic needs and early postoperative pain.
- Effective pain management is crucial for pediatric surgical recovery.
Purpose of the Study:
- To compare the postoperative analgesic efficacy of oral acetaminophen and ketorolac.
- To evaluate their effectiveness when administered 30 minutes before anesthesia induction for bilateral myringotomy in children.
Main Methods:
- A double-blind, placebo-controlled study included 90 healthy children (ASA I or II) undergoing bilateral myringotomy.
- Patients received saline (placebo), acetaminophen (10 mg/kg), or ketorolac (1 mg/kg) orally before anesthesia.
- Postoperative pain was assessed by a blinded observer using an objective pain scale.
Main Results:
- The ketorolac group exhibited significantly lower postoperative pain scores and required less frequent analgesia compared to acetaminophen and placebo groups.
- No significant difference in pain scores or analgesic needs was observed between the acetaminophen and placebo groups.
- Demographics, anesthesia/surgery duration, recovery times, and emesis incidence were similar across all groups.
Conclusions:
- Preoperative oral ketorolac provides superior postoperative pain control compared to placebo in children undergoing bilateral myringotomy.
- Preoperative oral acetaminophen did not demonstrate a significant analgesic advantage over placebo for this procedure.
- Ketorolac is a more effective prophylactic analgesic option than acetaminophen for pediatric myringotomy patients.
Abstract:
Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a double-blind, placebo-controlled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml.kg-1), acetaminophen (10 mg.kg-1) or ketorolac (1 mg.kg-1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.