Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy

• Published in: Acta anaesthesiologica Scandinavica Vol. 42; no. 7; pp. 770 - 775
• Main Authors: Rømsing, J., ØStergaard, D., Walther-Larsen, S., Valentin, N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.1998; Blackwell
• Subjects: Acetaminophen - administration & dosage; Acetaminophen - therapeutic use; Adolescent; Analgesics; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - adverse effects; Analgesics, Non-Narcotic - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; bleeding; Child; Child, Preschool; children; Double-Blind Method; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Incidence; Injections, Intravenous; Ketorolac; Male; Medical sciences; Neuropharmacology; Pain Measurement; Pain, Postoperative - prevention & control; Pharmacology. Drug treatments; Placebos; Postoperative analgesia; Postoperative Complications - prevention & control; Postoperative Hemorrhage - etiology; Premedication; Safety; Tolmetin - administration & dosage; Tolmetin - adverse effects; Tolmetin - analogs & derivatives; Tolmetin - therapeutic use; Tonsillectomy; Vomiting - prevention & control; Human; Postoperative; Toxicity; Ketorolac; Hemorrhage; Non steroidal antiinflammatory agent; Prevention; Analgesia; Chemotherapy; Analgesic; Pain; Treatment; Tonsillectomy; Vomiting; Surgery; Digestive diseases; Preoperative; Child; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.1998.tb05320.x

Background: Tonsillectomy is a common procedure in childhood resulting in significant morbidity due to pain. The aim of this study was to evaluate the analgesic efficacy and safety of a single dose of ketorolac i.v. given before or after tonsillectomy, compared to placebo. Methods: A randomized, double‐blind, placebo‐controlled study was performed in 60 children, 5 to 15 years of age, admitted for tonsillectomy Patients were allocated to receive ketorolac 1 mg . kg‐1 i.v. or placebo. Postoperative pain was assessed by self‐report 1.5, 3, 5, and 24 h after surgery. Results: Pain scores were significantly lower for both ketorolac groups compared to the placebo group 1.5, 3, and 5 h after surgery (P<0.05). Pain scores were lowest in the preoperative ketorolac group 1.5 to 5 h after surgery, and significantly fewer children in this group had fentanyl 0 to 1.5 h after surgery. But no significant differences were found between pain scores of the preoperative and postoperative ketorolac groups in the first 24 h after surgery. Acetaminophen consumption during the first 5 h after surgery was significantly less in patients receiving ketorolac (P<0.05). Patients in the preoperative ketorolac group had a significantly lower incidence of postoperative vomiting (P<0.05). There were no significant differences in the incidence of postoperative bleeding between groups. Three children in the preoperative, 5 children in the postoperative ketorolac group, and 5 children in the placebo group experienced postoperative haemorrhage. Conclusion: This study indicates that a single dose of ketorolac 1 mg . kg‐1 i.v. administered either before or immediately after surgery improves postoperative analgesia in children after tonsillectomy without evidence of increased incidence of bleeding.