Fentanyl sparing effects of combined ketorolac and acetaminophen for outpatient inguinal hernia repair in children.
OBJECTIVE
In this prospective, randomized, double-blinded study we sought to evaluate the efficacy and safety of combined use of intravenous ketorolac and acetaminophen in small children undergoing outpatient inguinal hernia repair.


METHODS
We studied 55 children 1 to 5 years old who were undergoing elective repair of unilateral inguinal hernia. After induction of general anesthesia children in the experimental group (28 patients) received 1 mg/kg ketorolac and 20 mg/kg acetaminophen intravenously. In the control group (27 patients) the same volume of saline was administered. All patients received 1 microg/kg fentanyl intravenously before incision. We also evaluated the number of patients requiring postoperative rescue fentanyl, total fentanyl consumption, pain scores and side effects.


RESULTS
Significantly fewer patients receiving ketorolac-acetaminophen received postoperative rescue fentanyl compared to controls (28.6% vs 81.5%). A significantly lower total dose of fentanyl was administered to patients receiving ketorolac-acetaminophen compared to controls (0.54 vs 1.37 microg/kg). Pain scores were significantly higher in the control group immediately postoperatively but eventually decreased. The incidences of sedation use (55.6% vs 25.0%) and vomiting (33.3% vs 10.7%) were significantly higher in controls.


CONCLUSIONS
Preoperative intravenous coadministration of ketorolac and acetaminophen is a simple, safe and effective method for relieving postoperative pain, and demonstrates highly significant fentanyl sparing effects in small children after outpatient inguinal hernia repair.
Hong
Jeong-Yeon
JY
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. jenyhongg@yuhs.ac
Won Han
Sang
S
Kim
Won Oak
WO
Kil
Hae Keum
HK
D000082:Acetaminophen / Q000008:administration & dosage*; D000556:Ambulatory Surgical Procedures; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D020910:Ketorolac / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D005283:Fentanyl; D020910:Ketorolac