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Recovery and complications after tonsillectomy in children: a comparison of ketorolac and morphine
J B Gunter1, A M Varughese, J F Harrington
1Department of Anesthesia, University of Cincinnati College of Medicine, Ohio, USA.
Insights
Ketorolac reduced vomiting after tonsillectomy compared to morphine, but increased major bleeding risk within 24 hours. Both drugs showed similar recovery times and overall bleeding incidence in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Complications
Background:
- Post-tonsillectomy pain and nausea are common in children.
- Opioids like morphine are standard for pain, but can cause side effects.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ketorolac are alternatives, but their safety and efficacy post-tonsillectomy require evaluation.
Purpose of the Study:
- To compare the efficacy and safety of intravenous ketorolac versus morphine for pain management in children undergoing tonsillectomy.
- To assess recovery variables and complication rates, including emesis and bleeding, between the two analgesic groups.
Main Methods:
- A prospective, randomized, double-blind study involving 96 children post-tonsillectomy.
- Children received either morphine (0.1 mg/kg) or ketorolac (1 mg/kg) intravenously.
- Recovery, emetic episodes, and bleeding complications were monitored during hospitalization and via follow-up at 24 hours and 14 days.
Main Results:
- No significant differences were observed in awakening time, oxygen requirements, or discharge readiness between ketorolac and morphine groups.
- Ketorolac significantly reduced the number of emetic episodes post-discharge from the postanesthesia care unit (PACU).
- Ketorolac was associated with a higher incidence of major bleeding requiring intervention within the first 24 hours post-surgery.
Conclusions:
- Ketorolac effectively reduces post-tonsillectomy emesis in children compared to morphine.
- However, ketorolac use is linked to an increased risk of significant bleeding in the initial 24 hours post-surgery.
- The choice between ketorolac and morphine should consider the trade-off between reduced nausea and increased bleeding risk.
Abstract:
Ninety-six children received morphine 0.1 mg/kg (n = 47) or ketorolac 1 mg/kg (n = 49) intravenously (IV) in a prospective, randomized, double-blind fashion, after tonsillectomy. Recovery variables and complications were recorded while subjects were in the hospital and parent(s) were contacted 24 h and 14 days after surgery. There were no differences in demographics, surgical management, awakening time, oxygen requirements, or time to readiness for postanesthesia care unit (PACU) discharge or discharge home between the two groups. Ketorolac subjects had fewer emetic episodes than morphine subjects (median 1 vs 3; P = 0.006) and were less likely to have more than two episodes of emesis after PACU discharge (9/49 vs 22/47; P = 0.007). Ketorolac subjects had more major bleeding (bleeding requiring intervention; 5/49 vs 0/47, one-tailed P = 0.03) and more bleeding episodes (0.22 episodes/subject vs 0.04 episodes/subject, P < 0.05) in the first 24 h after surgery, but no greater overall incidence of bleeding than the morphine subjects. In children having tonsillectomy, ketorolac, compared to morphine, reduced the number of emetic episodes after PACU discharge, but did not hasten awakening, readiness for PACU discharge or discharge home, and increased the likelihood of major bleeding in the first 24 h after surgery.