Ketorolac reduces postoperative narcotic requirements.
OBJECTIVE
Adverse effects from narcotics complicate pain management in children. Ketorolac, a potent nonsteroidal antiinflammatory agent can be used as an adjuvant analgesic, yet concerns of bleeding and nephrotoxicity have limited routine use. The authors hypothesized that postoperative use of ketorolac in healthy pediatric surgical patients would limit narcotic requirements without increasing morbidity.


METHODS
A case-control clinical trial was conducted of 29 pediatric surgical cases prospectively administered ketorolac (0.5 mg/kg intravenously every 6 hours) supplemented with morphine. Controls receiving morphine only were matched for age (+/- 6 months) and surgical procedure. Incidence of respiratory depression, urinary retention, emesis, nephrotoxicity, and bleeding were recorded.


RESULTS
Patients receiving ketorolac plus morphine had significantly less morphine requirements in the first 48 postoperative hours (Ketorolac plus Morphine: 0.36+/-0.16 mg/kg/d, Morphine only: 1.08+/-0.16 mg/kg/d [P<.05, analysis by paired t test]). This decrease was noted despite mode of analgesia (patient controlled or nurse administered). Adverse effects of morphine including respiratory depression, emesis, and urinary retention were not affected by ketorolac. Patients administered ketorolac had no significant increase in bleeding or nephrotoxicity.


CONCLUSIONS
Ketorolac exhibits significant opiate-sparing effects in the immediate postoperative period without introducing additional morbidity to pediatric surgical procedures.
Carney
D E
DE
Department of Surgery, Upstate Medical University, Syracuse, NY, USA.
Nicolette
L A
LA
Ratner
M H
MH
Minerd
A
A
Baesl
T J
TJ
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D020910:Ketorolac