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Comparison of ketorolac and morphine as adjuvants during pediatric surgery
M F Watcha1, M B Jones, R G Lagueruela
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
Insights
Ketorolac and morphine provide effective postoperative pain relief in children undergoing surgery. Ketorolac was associated with less nausea and vomiting compared to morphine.
Area of Science:
- Anesthesiology
- Pediatric Pain Management
- Pharmacology
Background:
- Opioid analgesics reduce anesthetic needs and provide early postoperative pain relief.
- Intraoperative interventions are crucial for managing pediatric surgical pain.
- Non-opioid analgesics are explored as alternatives to minimize opioid-related side effects.
Purpose of the Study:
- To compare the efficacy of intraoperative ketorolac versus morphine for postoperative analgesia in children.
- To evaluate postoperative pain scores and analgesic requirements.
- To assess the incidence of postoperative nausea and vomiting (PONV).
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 95 children (ages 5-15).
- Intravenous administration of saline, morphine (0.1 mg/kg), or ketorolac (0.9 mg/kg) after anesthesia induction.
- Postoperative pain assessed using Visual Analog Scale (VAS) and Objective Pain Scale (OPS) in the Post-Anesthesia Care Unit (PACU).
Main Results:
- No significant difference in pain scores or analgesic needs between ketorolac and morphine groups.
- Placebo group showed significantly higher pain scores and required more analgesia.
- Ketorolac group experienced less postoperative emesis than the morphine group.
Conclusions:
- Intraoperative ketorolac (0.9 mg/kg IV) is an effective alternative to morphine (0.1 mg/kg IV) for pediatric surgical patients.
- Ketorolac offers comparable analgesia to morphine with a potential reduction in PONV.
- This study supports ketorolac as a valuable adjuvant during general anesthesia in children.
Abstract:
The intraoperative use of opioid analgesics decreases the volatile anesthetic requirement and provides for pain relief in the early postoperative period. In a randomized double-blind, placebo-controlled study involving 95 ASA physical status 1 or 2 children (ages 5-15 yr) undergoing general anesthesia for elective operations, we compared postoperative analgesia following the intraoperative intravenous (iv) administration of ketorolac, a nonsteroidal antiinflammatory drug or morphine, an opioid analgesic. After induction of general anesthesia and before the start of the surgical procedure, children received equal volumes of saline, morphine (0.1 mg.kg-1, iv) or ketorolac (0.9 mg.kg-1, iv). Postoperative pain was evaluated by the child using a 10-cm linear visual analog scale (VAS) and by a blinded observer using both a VAS and an objective pain scale (OPS) in the postanesthesia care unit (PACU). There were no statistically significant differences in the VAS and OPS scores in the PACU or in the postoperative analgesic requirements in children receiving morphine or ketorolac. The placebo group had a significantly higher VAS and OPS score and required earlier and more frequent analgesic therapy in the PACU compared to the two analgesic groups. Patients receiving ketorolac had less postoperative emesis than those receiving morphine. We conclude that ketorolac (0.9 mg.kg-1) is an effective alternative to morphine (0.1 mg.kg-1) as an iv adjuvant during general anesthesia, and in the dose used in this study, is associated with less postoperative nausea and vomiting in children.