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Ketorolac in Postoperative Neonates and Infants: A Systematic Review
Insights
Ketorolac effectively manages pain in infants under six months, showing efficacy and minimal adverse effects in properly selected neonates and infants. Further randomized trials are needed to confirm these findings.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Pain Management
Background:
- Postoperative pain management in infants younger than 6 months presents unique challenges.
- Limited data exists on the use of non-opioid analgesics like ketorolac in this population.
Purpose of the Study:
- To evaluate the pharmacokinetics, pharmacodynamics, dosing, efficacy, and safety of ketorolac in postoperative infants.
- To assess ketorolac's suitability for pain management in neonates and young infants.
Main Methods:
- A systematic literature search was conducted across PubMed, Medline, and EBSCO Discovery Service (1988-July 2020).
- Included English-language articles focused on ketorolac use in infants under 6 months of age.
Main Results:
- Eight reports involving 239 infants were analyzed, with 237 under 6 months.
- Ketorolac demonstrated rapid elimination (half-life 0.83 hours) and effective analgesia, evidenced by reduced morphine use and lower Neonatal/Infant Pain Scale scores.
- Adverse effects were minimal in term neonates and infants without renal dysfunction.
Conclusions:
- While randomized controlled trials are lacking, published reports indicate ketorolac's efficacy and safety in carefully selected infants.
- Ketorolac appears to be a viable option for postoperative pain management in this pediatric population when used appropriately.
Objective:
To evaluate the pharmacokinetics and pharmacodynamics, dosing, efficacy, and safety of ketorolac in postoperative patients younger than 6 months of age.
Methods:
PubMed (1988-July 2020), Medline (1946-July 2020), and EBSCO Discovery Service (1988-July 2020) were searched to identify relevant published articles using the following search terms: ketorolac, neonate, infant. English-language articles evaluating the use of ketorolac in infants younger than 6 months of age were included.
Results:
Eight reports that included 239 infants receiving ketorolac were included. Of the included patients, 237 were younger than 6 months of age. Ketorolac exhibits rapid elimination of the analgesia-producing S (-) isomer, elimination half-life of 0.83 hours. Most patients received 0.5 mg/kg/dose every 6 hours for 48 to 72 hours. Analgesia was demonstrated by reduced use of open-label morphine and significant lowering of Neonatal/Infant Pain Scale scores. Adverse effects were minimal when ketorolac was used in term neonates and infants without baseline renal dysfunction.
Conclusions:
Randomized placebo-controlled trials of ketorolac use in this population are lacking; however, most published reports noted efficacy and safety with ketorolac in properly selected infants.
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