Bimodal analgesia vs fentanyl in pediatric patients undergoing bilateral myringotomy and tympanostomy tube placement: a propensity matched cohort study.
OBJECTIVE
Bilateral myringotomy and tympanostomy tube placement (BMT) is one of the most frequently performed pediatric outpatient procedures with 667,000 children receiving tympanostomy tubes annually. Because of this high volume, discovering the ideal analgesic regimen may lead to decreased overall postanesthesia care unit (PACU) costs while increasing patient and parent satisfaction. The purpose of this study is to determine if there is any benefit in supplementing intranasal (IN) fentanyl with intramuscular (IM) ketorolac with regard to immediate recovery characteristics.


METHODS
Retrospective, cohort study.


METHODS
University-affiliated teaching hospital.


METHODS
One thousand one hundred forty American Society of Anesthesiologists physical status 1 and 2 pediatric patients scheduled for BMT.


METHODS
No interventions were performed.


METHODS
A propensity matched cohort of pediatric patients who underwent BMT at Vanderbilt Children's Hospital from 2011 to 2014 was analyzed. The authors compared PACU recovery time, rescue analgesic administration, maximal PACU pain scores, and maximal PACU agitation scores between subgroups of patients given either IN fentanyl and IM ketorolac or IN fentanyl alone intraoperatively.


RESULTS
After adjusting for patient demographics and fentanyl dose, the fentanyl/ketorolac group received rescue analgesics 4.7% (95% confidence interval [CI], 2.0%-7.5%) less often, displayed moderate to severe pain 4.7% (95% CI, 1.5%-8.0%) less often, and experienced emergence agitation 3.6% (95% CI, 1.5%-5.8%) less often than patients in the fentanyl-only group. This corresponded to a relative risk reduction of 127%, 76%, and 200%, respectively.


CONCLUSIONS
Based on our retrospective analysis, adding IM ketorolac to IN fentanyl may be beneficial to pediatric patients undergoing BMT. However, these results should be confirmed with a prospective, double-blinded, randomized study.
Lincoln Memorial University, DeBusk College of Osteopathic Medicine, 6965 Cumberland Gap Pkwy, Cumberland Gap, TN 37724, USA.
Maxie L
ML
Phillips
Meharry Medical College, 1005 Doctor D.B. Todd Junior Blvd, Nashville, TN 37208, USA.
Bryan C
BC
Willis
Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA.
Aaron J
AJ
Broman
Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA.
Humphrey V
HV
Lam
Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA.
Thanh T
TT
Nguyen
Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA. Electronic address: thomas.austin@vanderbilt.edu.
Thomas M
TM
Austin
D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D020910:Ketorolac / Q000627:therapeutic use*; D008297:Male; D008876:Middle Ear Ventilation; D010149:Postoperative Pain / Q000188:drug therapy*; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005283:Fentanyl; D020910:Ketorolac
Agitation; Analgesia; Myringotomy; Pain; Recovery; Rescue