Intraoperative ketorolac is an effective substitute for fentanyl in children undergoing outpatient adenotonsillectomy.
BACKGROUND
In this prospective randomized double-blind study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of ketorolac vs fentanyl in dexamethasone-pretreated children undergoing ambulatory adenoidectomy and laser-assisted tonsillectomy (ADLAT). We evaluated the hypothesis that avoiding the use of opioids and replacing them with an equianalgesic dose of ketorolac, a nonsteroidal anti-inflammatory drug, would reduce the incidence of postoperative nausea and vomiting (PONV).


METHODS
Fifty-seven ASA I and II children aged 1.710 years who underwent ADLAT were randomized to receive either intravenous ketorolac (1 mg.kg(-1)) or fentanyl (2 microg.kg(-1)) for pain control during a standardized general anaesthetic with propofol infusion. The early (postanaesthesia care unit, day surgical area) and late postoperative courses were compared between the groups.


RESULTS
The incidence of PONV was low and equal in both groups. Postoperative pain scores were equal at all stages of followup. Agitation scores in the postanaesthesia care unit were significantly higher in the ketorolac group, but this had no effect on the late variables of behaviour studied.


CONCLUSIONS
Ketorolac showed no advantage over fentanyl in reducing the incidence of PONV in children undergoing ADLAT.
Keidan
Ilan
I
Department of Anaesthesia and Intensive Care, Sheba Medical Centre, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. keidan@012.net.il
Zaslansky
Ruth
R
Eviatar
Ephraim
E
Segal
Samuel
S
Sarfaty
Shlomo M
SM
D000233:Adenoidectomy; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D020910:Ketorolac / Q000627:therapeutic use*; D053685:Laser Therapy; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011292:Premedication; D011446:Prospective Studies; D014068:Tonsillectomy
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D003907:Dexamethasone; D005283:Fentanyl; D020910:Ketorolac