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Incidence of bleeding in children undergoing circumcision with ketorolac administration
Bruce Gao1, Taylor Remondini1, Navraj Dhaliwal1
1Undergraduate Medicine, University of Calgary, Calgary, AB; Canada.
Insights
Ketorolac use in pediatric circumcision may increase bleeding risk. Further research is needed to ensure safe pain management for this common procedure.
Area of Science:
- Pediatric Urology
- Pain Management
- Surgical Outcomes
Background:
- Circumcision is a common pediatric urological procedure.
- Ketorolac offers effective pain relief with fewer side effects than morphine.
- Concerns exist regarding ketorolac's potential to increase perioperative bleeding.
Purpose of the Study:
- To evaluate the association between ketorolac use and postoperative bleeding in pediatric circumcision patients.
- To assess institutional outcomes related to ketorolac and bleeding after circumcision.
Main Methods:
- Retrospective review of 475 pediatric circumcision cases from January 2014 to December 2015.
- Data collection included demographics, analgesic regimens, and bleeding-related emergency department/clinic returns.
- Comparison of outcomes between patients receiving ketorolac and those receiving standard analgesia.
Main Results:
- 13% of ketorolac recipients returned for bleeding vs. 5.0% of non-recipients (p=0.005).
- 64% of ketorolac recipients experienced sanguineous drainage vs. 46% of non-recipients (p<0.001).
- No significant differences in hospital admission or need for further medical intervention were observed.
Conclusions:
- Ketorolac, while effective for pain, is associated with an increased risk of bleeding after pediatric circumcision.
- Additional investigation is warranted to determine safe ketorolac usage protocols for circumcisions.
- Careful consideration of ketorolac's risks and benefits is recommended for pain management in this population.
Introduction:
Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding.
Methods:
We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children's Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review.
Results:
A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group 19/150 [13%], non-ketorolac group 16/325 [5.0%]; p=0.005). Patients receiving ketorolac were more likely to have postoperative sanguineous drainage (ketorolac group 96/150 [64%], non-ketorolac group 150/325 [46%]; p<0.001). There was no significant difference in the number of patients requiring postoperative admission or further medical intervention.
Conclusions:
Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.
