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Comparison of intravenous ketorolac with morphine for postoperative pain in children
E L Maunuksela1, H Kokki, R E Bullingham
1Department of Ophthalmology, Helsinki University Hospital, Finland.
Insights
For children
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Postsurgical pain management in children is crucial for recovery.
- Intravenous analgesics are commonly used for moderate to severe pain.
- Optimizing pain relief while minimizing side effects is a clinical priority.
Purpose of the Study:
- To compare the efficacy and duration of analgesia of intravenous morphine versus ketorolac in children.
- To evaluate ketorolac administered via titration versus bolus injection for postsurgical pain control.
Main Methods:
- A double-blind, randomized, parallel-group study involving 92 children (3-12 years).
- Participants received intravenous morphine, ketorolac by titration, or ketorolac by bolus injection.
- Pain scores were assessed regularly post-administration for up to 8 hours.
Main Results:
- Both morphine and ketorolac provided pain relief, with morphine requiring fewer doses initially.
- Ketorolac groups showed better sustained pain relief after initial pain management.
- Median analgesia durations were 170 minutes (morphine), 190 minutes (ketorolac titration), and 225 minutes (ketorolac bolus).
- Injection site pain was the most common side effect.
Conclusions:
- Intravenous ketorolac offers sustained analgesia in children post-surgery, with a slower onset but longer duration compared to morphine.
- Ketorolac bolus injection provided the longest duration of pain relief.
- Both agents are effective, but ketorolac may be advantageous for prolonged pain management.
Abstract:
Ninety-two children from 3 to 12 years of age were given intravenous morphine or ketorolac by titration, or ketorolac by bolus injection for moderate or severe postsurgical pain in a double-blind randomized parallel-group study. Pain scores were assessed every 5 minutes until pain relief was complete, and then every 15 minutes for 8 hours or until pain returned. Twenty-nine of 30 patients receiving morphine and 25 of 30 patients in each group receiving ketorolac achieved pain relief. The subjects in the morphine group required statistically fewer doses for analgesia than the subjects in the ketorolac groups. The sums of pain intensity differences calculated from the start of the study numerically favored morphine, but the sum of pain intensity differences from pain relief until 50% withdrew were significantly better in the ketorolac groups. Median durations of analgesia from initial drug administration were 170, 190, and 225 minutes in the morphine, ketorolac titration, and ketorolac bolus groups, respectively. The most common side effect was injection site pain. Analgesia after intravenous ketorolac developed more slowly but was sustained better than morphine.