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Published on: November 6, 2019
Acetaminophen or ketorolac for post myringotomy pain in children? A prospective, double-blinded comparison
J D Bean-Lijewski1, J C Stinson
1Department of Anesthesiology, Scott and White Clinic, Temple, Texas, USA.
Insights
Acetaminophen (paracetamol) offers comparable pain relief to ketorolac for children undergoing ear tube surgery, making it a more cost-effective choice. The slight, short-term pain reduction from ketorolac does not outweigh its higher cost.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Myringotomy with tube placement (BMT) is the most common pediatric surgical procedure.
- Effective pain management is crucial for pediatric surgical recovery.
- Evaluating cost-effectiveness of analgesics is important in healthcare.
Purpose of the Study:
- To compare the analgesic efficacy and cost-effectiveness of acetaminophen versus ketorolac in children undergoing BMT.
- To determine if ketorolac provides superior pain relief compared to acetaminophen in this pediatric population.
Main Methods:
- Prospective, double-blinded, randomized study involving 132 children (6 months to 9 years) undergoing elective BMT.
- Children received either oral acetaminophen (15 mg/kg) or ketorolac (1 mg/kg) 30 minutes preoperatively.
- Pain was assessed using the Objective Pain Scale at multiple time points; awakening, PACU, and discharge times were recorded.
Main Results:
- Median pain scores were lower in the ketorolac group at 5 and 10 minutes postoperatively.
- No significant differences were observed in pain scores at discharge or in postdischarge analgesic requirements between the groups.
- Demographics, side effects, and time to discharge were comparable between the acetaminophen and ketorolac groups.
Conclusions:
- While ketorolac offered a slight, short-term analgesic advantage, it did not justify the increased cost compared to acetaminophen.
- Acetaminophen is a cost-effective analgesic option for pediatric patients undergoing myringotomy with tube placement.
- The findings suggest that acetaminophen provides adequate pain management for this common pediatric surgical procedure.
Abstract:
Myringotomy with tube placement (BMT) is the most frequent surgical procedure performed in children. The purpose of this prospective, double-blinded study was to determine if 15 mg.kg-1 of acetaminophen (paracetamol) provides analgesia similar to that provided by ketorolac, 1 mg.kg-1, at a lower cost. One-hundred-and-thirty-two children, ages six months to nine years, scheduled for elective BMT were randomized to receive oral acetaminophen or ketorolac 30 min preoperatively. An Objective Pain Scale score was assessed upon arrival to the PACU and at five, ten and 20 min. Time of awakening, time of PACU and day surgery discharge and incidence of vomiting were recorded. Groups were comparable in demographics, side effects and time to discharge. Median pain scores were lower in the ketorolac group at five and ten min but no differences were seen at discharge nor in postdischarge analgesic requirements. Is ten min of better analgesia worth the cost of ketorolac? We conclude that the slight analgesic benefit from ketorolac does not justify its cost in this setting.
