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Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine
1Department of Anesthesiology, Children's Hospital Medical Center, Akron, OH.
Insights
A single dose of intravenous ketorolac reduced morphine use and pain scores in pediatric patients. This intervention also decreased urinary retention, improving postoperative recovery during patient-controlled analgesia.
Area of Science:
- Anesthesiology and Pain Management
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative pain management in children often involves patient-controlled analgesia (PCA) with morphine.
- Opioid-related side effects and dose requirements are significant concerns in pediatric PCA.
- Non-opioid analgesics are explored to optimize pain control and reduce opioid burden.
Purpose of the Study:
- To evaluate the impact of a single intraoperative dose of intravenous ketorolac on postoperative opioid consumption.
- To assess the effect of ketorolac on patient-reported pain quality during pediatric PCA.
- To determine the influence of ketorolac on the incidence of opioid-related side effects in pediatric surgical patients.
Main Methods:
- Prospective, randomized, double-blind study conducted in a children's hospital.
- 50 orthopedic surgical patients (ages 8-16) received either intravenous ketorolac or placebo at wound closure.
- All patients utilized morphine PCA postoperatively, with pain scores and side effects monitored for 12 hours.
Main Results:
- Patients receiving ketorolac required significantly less morphine via PCA in the first 12 hours postoperatively (p = 0.002).
- The ketorolac group reported significantly lower visual analog scale (VAS) pain scores (p < 0.01).
- A significant reduction in urinary retention was observed in the ketorolac group compared to the placebo group (p = 0.02).
Conclusions:
- Intraoperative intravenous ketorolac effectively reduces opioid requirements in pediatric PCA.
- Ketorolac administration improves postoperative analgesia quality in pediatric surgical patients.
- A single dose of ketorolac decreases the incidence of urinary retention, a common opioid-related side effect.
Study Objective:
To assess the effects of a single intraoperative dose of intravenous (i.v.) ketorolac on postoperative opioid dose requirements, quality of analgesia as assessed by the patient, and frequency of opioid-related side effects during pediatric patient-controlled analgesia (PCA) with morphine.
Design:
Prospective, randomized, double-blind study.
Setting:
Operating rooms, postanesthesia care unit (PACU), and inpatient care units of a freestanding children's hospital.
Patients:
50 ASA physical status I-II orthopedic surgical patients ages 8 to 16 years.
Interventions:
Either 0.8 mg/kg of i.v. ketorolac or no additional analgesic was administered at the time of wound closure. After surgery, all patients were placed on PCA with morphine.
Measurements And Main Results:
Individual morphine use during the first 12 hours of PCA therapy was recorded. A visual analog scale (VAS) pain score was obtained from the patient at the time of discharge from the PACU and at 4, 8, and 12 hours postoperatively. Any vomiting, pruritus, or urinary retention occurring during the first 12 postoperative hours was noted. The morphine plus ketorolac group administered significantly less PCA with morphine during the first 12 postoperative hours than did the morphine only group (p = 0.002). The morphine plus ketorolac group also reported significantly lower overall VAS pain scores (p < 0.01). Although similar frequencies of vomiting and pruritus were observed, the morphine plus ketorolac group experienced significantly less urinary retention than did the morphine group (p = 0.02).
Conclusion:
A single intraoperative dose of i.v. ketorolac appears to be opioid dose sharing, to provide superior analgesia, and to decrease the frequency of urinary retention during the first 12 hours of postoperative pediatric PCA with morphine.