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Bleeding and ketorolac use in pediatric circumcision
Jennifer Lee1, Eric P Zhou2, Renee L Davis1
1Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Intraoperative ketorolac did not increase the risk of significant postoperative bleeding in pediatric circumcision patients. This finding suggests ketorolac can be safely used for pain management in this population.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Circumcision is a common pediatric surgical procedure.
- Ketorolac is an effective pain management option.
- Concerns exist regarding ketorolac's potential to increase bleeding risk.
Purpose of the Study:
- To compare the risk of clinically significant postoperative bleeding after pediatric circumcision with and without intraoperative ketorolac administration.
Main Methods:
- Retrospective cohort study of 743 pediatric patients (1-18 years) undergoing isolated circumcision.
- Clinically significant bleeding defined as requiring intervention within 24 hours.
- Interventions included hemostats, sutures, or return to OR.
Main Results:
- 42.3% received ketorolac (0.5 mg/kg), 57.7% did not.
- Bleeding requiring intervention occurred in 0.32% of the non-ketorolac group vs. 0.93% of the ketorolac group.
- No statistically significant difference in bleeding rates (p=0.403).
Conclusions:
- Intraoperative ketorolac administration is not associated with a statistically significant increase in postoperative bleeding after pediatric circumcision.
- Ketorolac may be a safe option for multimodal pain control in this patient group.
- Further research is warranted to confirm these findings.
Background:
Circumcision is a common surgical procedure performed in pediatric male patients. Ketorolac is an effective adjunct in multimodal regimens for postoperative pain control. However, many urologists and anesthesiologists refrain from administering ketorolac due to concern for postoperative bleeding.
Aims:
Compare the risk of clinically significant bleeding after circumcision with and without intraoperative ketorolac administration.
Methods:
A single-center, retrospective cohort study was conducted of pediatric patients 1-18 years of age who underwent isolated circumcision by one urologist from 2016 to 2020. Clinically significant bleeding was defined as bleeding requiring intervention within the first 24 h of circumcision. Interventions included use of absorbable hemostats, placement of sutures, or return to the operating room.
Results:
Of 743 patients, 314 (42.3%) did not receive ketorolac and 429 (57.7%) received intraoperative ketorolac 0.5 mg/kg. Postoperative bleeding requiring intervention occurred in one patient (0.32%) in the non-ketorolac group versus four patients (0.93%) in the ketorolac group (difference 0.6%, 95% CI [-0.8%, 2.0%], p = 0.403).
Conclusions:
There was no statistically significant difference in postoperative bleeding requiring intervention between the non-ketorolac and ketorolac groups. Future studies regarding the association between ketorolac and postoperative bleeding are needed.
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