Ketorolac in neonates and infants following congenital heart surgery: a retrospective review

• Published in: Cardiology in the young Vol. 34; no. 6; p. 1199
• Main Authors: Kiskaddon, Amy L, Stock, Arabela C, Fierstein, Jamie L, Miller, Alexandra, Quintessenza, James A, Goldenberg, Neil
• Format: Journal Article
• Language: English
• Published: England 01.06.2024
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Cardiac Surgical Procedures - adverse effects; Female; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Ketorolac - administration & dosage; Ketorolac - adverse effects; Ketorolac - therapeutic use; Male; Pain Management - methods; Pain, Postoperative - drug therapy; Retrospective Studies; neonate; infant; Ketorolac; congenital heart surgery
• ISSN: 1467-1107
• DOI: 10.1017/S1047951123004262

Pain management is essential in the immediate post-surgical period. We sought to describe the ketorolac dose regimen in neonates and infants following cardiac surgery. Secondary outcomes included renal dysfunction, bleeding, and pain management. We performed a single-centre retrospective cohort study of neonates and infants (aged < 12 months) who received ketorolac following cardiac surgery, from November 2020 through November 2021 (inclusive). Ketorolac was administered at 0.5 mg/kg every 6 hours. Safety was defined by absence of a clinically significant decline in renal function (i.e., increase in serum creatinine [SCr] by ≥ 0.3 mg/dL from baseline within 48 hours and/or urine output ≤ 0.5 mL/kg/hour for 6 hours) and absence of clinically significant bleeding defined as major by International Society on Thrombosis and Hemostasis paediatric criteria or Severe/Fatal Bleeding Events by Nellis et al. Efficacy measures included pain scores and opioid utilisation. Fifty-five patients met eligibility criteria. The median (range) dose and duration of ketorolac administration was 0.5 mg/kg/dose for 48 (6-90) hours. Among all patients, there was not a statistically significant difference observed in median SCr within 48 hours of baseline (p > .9). There were no major or severe bleeding events. The median (range) opioid requirements (morphine intravenous equivalents per kg per day) at 48 hours post-ketorolac initiation was 0.1 (0-0.8) mg/kg/day. If validated prospectively, these findings suggest that a ketorolac regimen 0.5 mg/kg/dose every 6 hours in neonates and infants post-cardiac surgery may be safe with regard to renal function and bleeding risk, and effective regarding opioid-sparing capacity.