The role of ketorolac in decreasing length of stay and narcotic complications in the postoperative pediatric orthopaedic patient.
The control of postoperative pain in the pediatric orthopaedic patient is a challenging endeavor. Several studies have shown the efficacy of ketorolac tromethamine in the pediatric general surgical population, but its efficacy in the pediatric orthopaedic population remains unproven. Twenty-seven consecutive patients (age 6 months to 18 years) who underwent long-bone osteotomies or foot procedures by a group of three pediatric orthopaedic surgeons were given a ketorolac protocol (1 mg/kg loading, 0.5 mg/kg every 6 h for 24 h). Breakthrough pain was managed with morphine until the patient was able to take oral pain medication, as was any pain after the 24-h period for ketorolac expired. Thirty-seven age- and case-matched patients were used as retrospective controls. The patients in the study who received ketorolac required significantly fewer doses of morphine than did the control group (2.29 +/- 3.98 vs. 10.02 +/- 3.39; p < 0.05). In addition the patients on the ketorolac protocol experienced fewer gastrointestinal side effects (4% vs. 32%; p < 0.05). Finally, the patients in the ketorolac group had a significantly shorter length of stay (3.63 +/- 1.64 days vs. 4.74 +/- 1.76 days; p < 0.05). There were no bleeding complications in either group. Ketorolac is thus a safe and effective means of controlling postoperative pain in the pediatric orthopaedic population while avoiding the troubling maleffects seen with the exclusive use of morphine.
Eberson
C P
CP
Hasbro Children's Hospital, Providence, Rhode Island, USA.
Pacicca
D M
DM
Ehrlich
M G
MG
D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007223:Infant; D020911:Ketorolac Tromethamine; D007902:Length of Stay; D016555:Matched-Pair Analysis; D019637:Orthopedic Procedures; D010027:Osteotomy; D010149:Postoperative Pain / Q000517:prevention & control*; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives*; D014325:Tromethamine / Q000009:adverse effects / Q000031:analogs & derivatives*
D018712:Analgesics, Non-Narcotic; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D014046:Tolmetin