A Double-Blind Evaluation of Ketorolac Tromethamine Versus Acetaminophen in Pediatric Tonsillectomy

Abstract

The study was designed to compare intravenous ketorolac to rectal acetaminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsillectomy with or without adenoidectomy. In a randomized, prospective double-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). Bleeding was evaluated by measuring intraoperative blood loss and noting extra measures required to obtain hemostasis. Bleeding times were also measured before and during surgery. Pain was evaluated using a standard objective pain score for the first 3 h. Persistent pain was treated with morphine, acetaminophen, and codeine and recorded for 24 h. Blood for determination of acetaminophen levels was drawn at 20 and 40 min after the administration of study drugs. Pain scores were not significantly different between the ketorolac and acetaminophen groups. The majority of patients in both groups required additional opioid in the postoperative period. Acetaminophen levels were all less than the therapeutic range. Intraoperative bleeding times were normal in all patients, but blood loss was significantly higher in the ketorolac group (2.67 mL/kg) compared to the acetaminophen group (1.44 mL/kg), P = 0.025. Significantly more measures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dose rectal acetaminophen for analgesia in the patient undergoing tonsillectomy. Hemostasis during tonsillectomy was significantly more difficult to achieve in patients receiving ketorolac.

Acetaminophen analgesia in children: placebo effect and pain resolution after tonsillectomy

“…This supports the premise that pain scores of less than four in children are satisfactory, while those above six require medication [31]. We predict a decrease of 2.6 pain units at a target concentration of 10 mg/l.…”

The effect of ibuprofen on postoperative hemorrhage following tonsillectomy in children

“…The clinical significance of increased bleeding risk in tonsillectomy is conflicting. While some authors have found the risk to be significant [17][18][19], others have detected the risk to be nonsignificant [1,2,20,21]. Marret et al [19] found that postoperative use of NSAIDs increased the risk of re-operation for hemostasis after tonsillectomy in the meta-analysis.…”

How to Make Tonsillectomy a Safer Procedure: The Anaesthetist's View

“…However, paracetamol is a weak analgesic only [6]. Given alone for the treatment of tonsillectomy pain, it is often insufficient at the recommended doses [7,8,9]. It should therefore be combined with other analgesics.…”