Effect of ketorolac on bleeding time and postoperative pain in children: a double-blind, placebo-controlled comparison with meperidine.
OBJECTIVE
To determine whether ketorolac 0.75 mg/kg would provide a comparable degree of analgesia to that of meperidine 1 mg/kg in terms of postoperative opioid requirements and pain scores in children undergoing surgeries associated with mild to moderate postsurgical discomfort.


METHODS
Randomized, prospective, placebo-controlled, double-blinded study of the initial 6 postsurgical hours.


METHODS
University affiliated teaching hospital.


METHODS
90 healthy ASA status I and II children scheduled for elective general, orthopedic, or genitourinary procedures associated with mild to moderate postsurgical pain. Extensive surgical procedures associated with a significant risk of bleeding were excluded.


METHODS
Ketorolac 0.75 mg/kg, meperidine 1 mg/kg, or placebo (normal saline) was administered intramuscularly (IM) at the beginning of surgery.


RESULTS
Bleeding times were measured prior to and 180 minutes after study drug administration. Time to first rescue medication, total opioid requirement, pain scores, incidence of vomiting and length of stay were evaluated. Placebo-treated patients were rescued earlier (p < 0.0001) and required twice the rescue dosage (p = 0.013) when compared with either the ketorolac or meperidine groups. The ketorolac and meperidine groups did not differ with regard to time until first rescue, cumulative proportion requiring rescue, or the number of rescue doses required. A single dose of IM ketorolac prolonged bleeding time by 53 +/- 75 seconds (p = 0.006).


CONCLUSIONS
Ketorolac provided analgesia comparable to that of meperidine and significantly reduced opioid requirements. Since ketorolac was not associated with a reduction in postoperative vomiting or length of stay, and in view of the uncertain risk of bleeding, it offers no advantage over meperidine in the management of mild to moderate acute postsurgical pain.
Bean-Lijewski
J D
JD
Department of Anesthesiology, Scott & White Clinic, Temple, TX 76508, USA.
Hunt
R D
RD
D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D001760:Bleeding Time; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D020910:Ketorolac; D008297:Male; D008614:Meperidine / Q000009:adverse effects* / Q000627:therapeutic use*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000139:chemically induced*; D011446:Prospective Studies; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D008614:Meperidine; D014046:Tolmetin; D020910:Ketorolac