title: Ketorolac or fentanyl continuous infusion for post-operative analgesia in children undergoing ureteroneocystostomy.
abstract: BACKGROUND
  children undergoing ureteroneocystostomy suffer from post-operative pain due to the surgical incision and bladder spasm. A single-shot caudal block is a common technique for paediatric analgesia, but a disadvantage is the limitation of a short duration in spite of the additives co-administered. A few clinical trials have shown that ketorolac provides an effective post-operative analgesia and reduces the bladder spasms after ureteral implantation in children. We compared the efficacy of a continuous infusion of ketorolac and fentanyl in post-operative analgesia and bladder spasm in children who underwent ureteroneocystostomy.
  
  
  METHODS
  fifty-two children were allocated to the ketorolac group (Group K, n=26) and fentanyl group (Group F, n=26). After general anaesthesia, a caudal block was performed with 1.5 ml/kg of 0.15% ropivacaine. At the beginning of surgery, an infusion was started after the bolus injection of ketorolac 0.5 mg/kg or fentanyl 1 microg/kg. An infusion device was programmed to deliver ketorolac 83.3 microg/kg/h or fentanyl 0.17 microg/kg/h for 48 h.
  
  
  RESULTS
  two of Group F and three of Group K were excluded from the study. Post-operative pain scores were similar between the two groups. One of Group K (4%) and seven of Group F (30.4%) experienced bladder spasms. The rescue analgesic requirements were significantly less in Group K.
  
  
  CONCLUSIONS
  a Continuous infusion of ketorolac provided effective analgesia after operation in children who underwent ureteroneocystostomy as well as a low dosage of fentanyl. Ketorolac was more effective in reducing the frequency of bladder spasms and rescue analgesic requirements.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Jo
authors.forename: J Y
authors.initials: JY
authors.lastname: Hong
authors.forename: E K
authors.initials: EK
authors.lastname: Choi
authors.forename: H K
authors.initials: HK
authors.lastname: Kil
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D003559:Cystostomy; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D007677:Kidney Function Tests; D008111:Liver Function Tests; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D013035:Spasm / Q000517:prevention & control; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005283:Fentanyl; D020910:Ketorolac