Intravenous ketoprofen as an adjunct to patient-controlled analgesia morphine in adolescents with thoracic surgery: a placebo controlled double-blinded study.
BACKGROUND
Surgery to correct pectus deformities entail substantial destruction of the thoracic skeleton and thus may cause significant postoperative pain.


OBJECTIVE
To evaluate the efficacy of intravenous ketoprofen, a NSAID, as an adjunct to PCA morphine in pain treatment in children having pectus surgery.


METHODS
Thirty-one children aged 10-15 years completed the study according to protocol. Children (n=14) in the ketoprofen-group received ketoprofen 1mg/kg i.v. at the skin closure, and at 8 and 16 h after surgery, while children (n=17) in the placebo-group received normal saline, respectively. For rescue analgesia the patient had an access to PCA-morphine. The children expressed their pain by a coloured VAS.


RESULTS
Mean cumulative 24h morphine dose used was less in the ketoprofen-group (mean+/-SD: 490+/-240 microg/kg) than in the placebo-group (670+/-200 microg/kg) (mean difference 180 microg/kg, 95% CI for diff: 15-340 microg/kg, P=0.03). The area under the pain intensity-time-curve was lower in the ketorpofen-group (49+/-26 score hour) than in the placebo-group (68+/-24 score hour) (mean difference 21 score hour, 95% CI for diff: 3-40 score hour, P=0.026). There was no difference between the two groups in adverse events, 4/14 in the ketoprofen group and 8/17 in the placebo-group developed oxygen desaturation, and one patient in the ketoprofen-group developed bleeding at 5h after surgery.


CONCLUSIONS
Intravenous ketoprofen in adjunct to PCA morphine provided a significant opioid sparing effect and improved analgesia in children having chest wall correction surgery.
Rugyte
Danguole
D
Department of Anesthesiology, Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania. danguole.rugyte@kmuk.lt
Kokki
Hannu
H
D000293:Adolescent; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004357:Drug Synergism; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007275:Injections, Intravenous; D007660:Ketoprofen / Q000008:administration & dosage*; D009020:Morphine / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control*; D015990:Placebo Effect; D010919:Placebos; D012646:Self Administration; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D010919:Placebos; D009020:Morphine; D007660:Ketoprofen