I.v. intraoperative ketoprofen in small children during adenoidectomy: a dose-finding study

Abstract

We have investigated if a low dose of ketoprofen (0.3 mg kg-1) i.v., provided as good analgesia with less adverse effects than higher doses (1.0 and 3.0 mg kg-1) in 220 children, aged 1-7 yr, undergoing adenoidectomy, in a prospective, randomized, double-blind, placebo-controlled, parallel group study. The postoperative analgesic effect was notable even after the lowest dose of ketoprofen. However, the higher doses seemed to provide better analgesia with no increase in adverse events or intraoperative bleeding. None of the children experienced postoperative bleeding which would have required intervention or delayed discharge from hospital. This study confirms the efficacy and safety of intraoperative ketoprofen in children during adenoidectomy.

Postoperative Intravenous Patient-Controlled Analgesia in Thyroid Surgery: Comparison of Fentanyl and Ondansetron Regimens With and Without the Nonsteriodal Anti-Inflammatory Drug Ketorolac

“…This is linked to modifications of the coagulation system caused by treatment of even a very short duration. Although a retrospective study has shown an increase in perioperative bleeding and wall hematomas in patients treated for long periods with NSAIDs (45), prospective studies have not shown an increase in the risk of postoperative hemorrhage with treatments lasting less than 5 days and started during or after the operation (18,46,47). In our study, no cases of hematoma formation occurred.…”

“…Opioids can increase postoperative nausea and vomiting and other side effects, such as sedation, dizziness, urinary retention, and pruritus (12). NSAIDs, through synergistic action with opioids (13)(14)(15)(16), can reduce these systemic side effects (17,18). In thyroid surgery, use of NSAIDs like ketoprofen reduced the pain score, morphine requirements, and related side effects such as nausea and vomiting (19).…”

Current management of pediatric postoperative pain

“…Higher doses of ketorolac are not more effective [35,36]. Ketoprofen has a substantial analgesic efficacy at a dose of 0.3 mg/kg, while with higher doses of up to 3 mg/kg, more enhance analgesia is achieved without any increase in adverse effects [37,38].…”

“…The incidence of nausea and vomiting with morphine, buprenorphine and tramadol (Ultram ® , Johnson & Johnson, PA, USA) is often reported to be high because up to 50% of children may develop emesis [61][62][63][64]. Nausea and vomiting may occur significantly less often with fentanyl and sufentanil (Sufenta ® , Wyeth-Ayerst Laboratories, PA, USA) [38,47,[65][66][67].…”

“…Morphine doses above 0.1 mg/kg are associated with a greater than 50% incidence of vomiting [61,63]. With fentanyl at doses of 2 µg/kg or less, vomiting occurs very rarely [38,65,66]. In contrast to dose-dependency, the risk of nausea and vomiting appears not to vary between different administration routes [64].…”