Safety of intravenous ketorolac therapy in children and cost savings with a unit dosing system.
OBJECTIVE
To determine the incidence of side effects with the short-term use of intravenously administered ketorolac in children and the overall cost savings with a unit dosing system.


METHODS
We prospectively examined the incidence of complications arising from the intravenous administration of ketorolac to 1747 children (14,810 doses) during a 3-year, 3-month period and assessed cost savings resulting from dividing 60 mg syringes into 7.5, 15, 30, and 60 mg unit doses. Complications were recorded prospectively into a computerized database. Estimated drug costs to the pharmacy were calculated on the basis of the total numbers of each drug fraction administered, with allowance for 1O% wastage as a result of drug expiration.


RESULTS
Side effects occurring with ketorolac administration were rare. Four patients (0.2%) had hypersensitivity reactions to the drug, two of them possibly on the basis of latex allergy. Two patients (O.1%) had renal complications but were subsequently found to have underlying causes that could account for their renal symptoms. One patient (0.05%) had massive gastrointestinal bleeding in the postoperative period. With fractionation of 60 mg syringes, total drug cost to the pharmacy was $34,786, rather than the $86,639 that would have been spent had a single syringe been used for each dose.


CONCLUSIONS
Ketorolac proved safe for short-term intravenous use in children more than 1 year of age when patients with known contraindications to the use of non-steroidal antiinflammatory drugs were excluded. A considerable reduction in drug costs can be achieved with fractionation of premixed syringes into unit doses.
Houck
C S
CS
Department of Anesthesia, Children's Hospital, Boston, Massachusetts, USA.
Wilder
R T
RT
McDermott
J S
JS
Sethna
N F
NF
Berde
C B
CB
D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D016527:Drug Costs; D004342:Drug Hypersensitivity / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D015994:Incidence; D007223:Infant; D007256:Information Systems; D007275:Injections, Intravenous; D020910:Ketorolac; D007674:Kidney Diseases / Q000209:etiology; D007840:Latex / Q000009:adverse effects; D008509:Medication Systems / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000191:economics; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011446:Prospective Studies; D012449:Safety; D013594:Syringes; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007840:Latex; D014046:Tolmetin; D020910:Ketorolac