title: Perioperative ketorolac use in children undergoing lower extremity osteotomies.
abstract: BACKGROUND
  Ketorolac has previously been shown to afford good pain relief in children undergoing surgery. Due to concerns about potential complications, particularly nonunion, delayed union, and excessive blood loss, ketorolac use has been limited in pediatric orthopaedics. The goal of this study is to examine complications associated with the perioperative use of ketorolac in children undergoing lower extremity osteotomies.
  
  
  METHODS
  A retrospective review was conducted of 327 consecutive children undergoing osteotomy surgery who had a minimum of 6 months follow-up. Of the 327 patients, 299 patients (625 osteotomies) had received ketorolac perioperatively and 28 (57 osteotomies) had not.
  
  
  RESULTS
  There was no significant difference in the rate of either osseous or soft tissue complications between the 2 groups. There were no nonunions in either of the groups. Delayed union occurred in 5 of 682 osteotomies (0.7%), including 0.6% in the ketorolac group (4/625 osteotomies), and 1.8% (1/57 osteotomies) in the nonketorolac group (P=0.893). Wound complications occurred in 16/327 patients overall (4.9%), including 13/299 (4.3%) in the ketorolac group and 3/28 (10.7%) in the nonketorolac group (P=0.301). There was no significant difference in estimated blood loss (EBL) (P=0.584) or the need for blood transfusion (P=0.777) between the 2 groups. Of the 19 occasions when blood was transfused perioperatively in the ketorolac group, 15 patients had undergone unilateral (3 patients) or bilateral (12 patients) varus derotational osteotomy as part of their surgery. Overall, 15 of 113 patients (13.3%) in the ketorolac group who underwent unilateral or bilateral varus derotational osteotomy required blood transfusion, with rates of 31.8% (7/22) in those who had undergone concomitant pelvic osteotomy(ies) and 8.7% (8/91) in those who had not.
  
  
  CONCLUSIONS
  The results of this study support the safety of perioperative ketorolac use in children undergoing lower extremity osteotomies.
  
  
  METHODS
  Level III.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, CA 90027, USA. rkay@chla.usc.edu
authors.forename: Robert Michael
authors.initials: RM
authors.lastname: Kay
authors.forename: Michael
authors.initials: M
authors.lastname: Leathers
authors.forename: Michael P
authors.initials: MP
authors.lastname: Directo
authors.forename: Karen
authors.initials: K
authors.lastname: Myung
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020910:Ketorolac / Q000009:adverse effects / Q000627:therapeutic use*; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac