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IV perioperative ketoprofen in small children during adenoidectomy
E Nikanne1, H Kokki, K Tuovinen
1Department of Otorhinolaryngology, Kuopio University Hospital, Finland.
Insights
Perioperative intravenous ketoprofen reduced postoperative fentanyl use and pain in children undergoing adenoidectomy. This analgesic approach demonstrated significant opioid-sparing effects and improved pain scores without increasing adverse events.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Postoperative pain management in children is crucial.
- Adenoidectomy is a common pediatric surgical procedure often associated with moderate to severe pain.
- Opioid analgesics are frequently used but carry risks of adverse effects.
Purpose of the Study:
- To evaluate the analgesic and opioid-sparing effect of perioperative intravenous ketoprofen in children undergoing adenoidectomy.
- To compare the need for postoperative fentanyl and pain intensity between ketoprofen and placebo groups.
Main Methods:
- A randomized, double-blind, placebo-controlled, parallel group study.
- 164 children aged 1-7 years received either ketoprofen or saline placebo perioperatively.
- Fentanyl was administered during induction and as rescue analgesia.
Main Results:
- Fewer children in the ketoprofen group required postoperative fentanyl (64% vs 77%, P = 0.006).
- The total number of fentanyl doses was significantly smaller in the ketoprofen group (P = 0.012).
- Lower pain scores at rest and during swallowing were observed in the ketoprofen group (P = 0.028 and P = 0.001, respectively).
Conclusions:
- Perioperative intravenous ketoprofen effectively reduces postoperative opioid requirements in children after adenoidectomy.
- Ketoprofen provides superior pain relief compared to placebo in this pediatric population.
- Ketoprofen is a safe analgesic option for pediatric adenoidectomy, with no increase in adverse reactions observed.
Abstract:
We have investigated the analgesic and opioid sparing effect of perioperative i.v. ketoprofen in a randomized, double-blind, placebo-controlled, parallel group study in 164 children, aged 1-7 yr, after adenoidectomy. A standard anaesthetic method was used and all children received fentanyl 1 microgram kg-1 i.v. during induction. Children in the ketoprofen group received ketoprofen 1 mg kg-1 i.v. after induction of anaesthesia followed by an infusion of ketoprofen 1 mg kg-1 over 2 h. Children in the placebo group received 0.9% saline. All children received fentanyl 1 microgram kg-1 i.v. as rescue analgesia. In the ketoprofen group less children required postoperative fentanyl (64% vs 77%, P = 0.006) and the total number of fentanyl doses was smaller compared with the placebo group (mean 1.0 (SD 1.1) (95% confidence intervals (CI) 0.8-1.3) vs 1.5 (1.1) (95% CI 1.2-1.7), P = 0.012). Worst pain observed in the postanaesthesia care unit was also lower in the ketoprofen group both at rest (P = 0.028) and during swallowing (P = 0.001). There were no difference in the number of adverse reactions between the groups. No serious adverse reactions occurred.