Preoperative ketorolac increases bleeding after tonsillectomy in children.
OBJECTIVE
To compare the incidence of vomiting following codeine or ketorolac for tonsillectomy in children.


METHODS
We had planned to enrol 240 patients, aged 2-12 yr undergoing elective tonsillectomy into a randomized, single-blind study in University Children's Hospital. The study was terminated, after 64 patients because interim analysis of the data by a blinded non-study scientist concluded that the patients were at undue risk of excessive perioperative bleeding. After induction of anaesthesia by inhalation with N2O/halothane or with propofol 2.5-3.5 mg.kg-1 i.v., the children were administered 150 micrograms.kg-1 ondansetron and 50 micrograms.kg-1 midazolam. Maintenance of anaesthesia was with N2O and halothane in O2. Subjects were administered either 1.5 mg.kg-1 codeine im or 1 mg.kg-1 ketorolac i.v. before the commencement of surgery. Intraoperative blood loss was measured with a Baxter Medi-Vac Universal Critical Measurement Unit. Postoperative management of vomiting and pain was standardized. Vomiting was recorded for 24 hr after anaesthesia. Data were compared with ANOVA, Chi-Square analysis and Fisher Exact Test.


RESULTS
Thirty-five subjects received ketorolac. Demographic data were similar. The incidence of vomiting during the postoperative period was 31% in the codeine-group and 40% in the ketorolac-group. Intraoperative blood losses was 1.3 +/- 0.8 ml.kg-1 after codeine and 2.2 +/- 1.9 ml.kg-1 after ketorolac (mean +/- SD) P < 0.05. Five ketorolac-treated patients had bleeding which led to unscheduled admission to hospital, P < 0.05, Exact Test.


CONCLUSIONS
Preoperative ketorolac increases perioperative bleeding among children undergoing tonsillectomy without beneficial effects.
Splinter
W M
WM
Department of Anaesthesia, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Rhine
E J
EJ
Roberts
D W
DW
Reid
C W
CW
MacNeill
H B
HB
D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000704:Analysis of Variance; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D006221:Halothane / Q000008:administration & dosage; D006801:Humans; D020910:Ketorolac; D008874:Midazolam / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use; D006472:Oral Hemorrhage / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011292:Premedication; D015742:Propofol / Q000008:administration & dosage; D016037:Single-Blind Method; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014068:Tonsillectomy; D014839:Vomiting / Q000517:prevention & control
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000932:Antiemetics; D017294:Ondansetron; D014046:Tolmetin; D009609:Nitrous Oxide; D008874:Midazolam; D006221:Halothane; D003061:Codeine; D015742:Propofol; D020910:Ketorolac