Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine

Vetter, Thomas R.; Heiner, Elizabeth J.

doi:10.1016/0952-8180(94)90006-x

Cited by 81 publications

(28 citation statements)

References 15 publications

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“…1,7,9–11 Narcotics are known to have common side effects such as nausea, vomiting, respiratory depression, and constipation, which can be especially problematic in pediatric patients. 1,6,10,12 Despite this, NSAID use in the treatment of pain associated with bony injury and healing in children is now considered controversial.…”

mentioning

confidence: 99%

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Cappello

Nuelle

Katsantonis

et al. 2013

Journal of Pediatric Orthopaedics

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Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective at controlling pain in children, especially in the treatment of fractures. Adult animal and adult clinical studies demonstrate conflicting evidence for the inhibitory relationship between NSAIDs and fracture healing. Published pediatric orthopaedic clinical studies do not demonstrate an inhibitory effect of ketorolac on bone healing. Little is known about the effects of any NSAID on bone formation in juvenile animals. This study investigates the effects of the NSAID ketorolac on fracture healing in a juvenile rat model. Methods Unilateral surgically induced and stabilized tibial shaft fractures were created in 45 juvenile (3 to 4wk old) male Sprague-Dawley rats. Either ketorolac (5 mg/kg; n=24) or saline (0.9% normal saline; n=21) was then administered to the rats 6 d/wk by intraperitoneal injections. Animals were then randomly assigned into time groups and euthanized at 7 days (n=8 ketorolac, n=7 saline), 14 days (n=8 ketorolac, n=7 saline), or 21 days (n=8 ketorolac, n=7 saline) postfracture. Biomechanical analysis was performed using a custom-designed 4-point bending loading apparatus. Statistics for tibial stiffness and strength data were performed using software package Systat 11. Specimens were also evaluated histologically using hematoxylin and eosin staining. Results Strength and stiffness of all fractured tibiae increased over time from day 7 to day 21 regardless of treatment type. No statistical difference was found between the fractured tibiae strength or stiffness in the ketorolac or control-treated specimens at the same time point. In addition, the quality of the fracture callus was similar in both groups at each of the time points. Conclusions In this study of a juvenile rat model with a stabilized tibia fracture, fracture callus strength, stiffness, and histologic characteristics were not affected by the administration of ketorolac during the first 21 days of fracture healing. Clinical Relevance The absence of inhibitory effects of ketorolac on early juvenile rat fracture healing supports the clinical practice of utilizing NSAIDs for analgesia in children with long bone fractures.

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mentioning

confidence: 99%

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Cappello

Nuelle

Katsantonis

et al. 2013

Journal of Pediatric Orthopaedics

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“…Ketorolac has significant opioid-sparing effects 1,2 and is considered to be a useful postoperative analgesic medication. [3][4][5] Children may benefit from the use of ketorolac after surgery.…”

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confidence: 99%

The Pharmacokinetics of Ketorolac After Single Postoperative Intranasal Administration in Adolescent Patients

Drover

Hammer²,

Anderson³

2012

Anesthesia &Amp; Analgesia

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“…However, attention must be paid to postoperative bleeding after tonsillectomy [49]. A single bolus dose of intravenous ketorolac has been used for opioid dose sharing with superior analgesic effects [48,50]. Continuous infusion of ketorolac has also been shown to reduce both the frequency of bladder spasm and the analgesic requirements in children undergoing urological procedures [35].…”

Section: Systemic Analgesicsmentioning

confidence: 99%

Attention to postoperative pain control in children

Lee

2014

Korean J Anesthesiol

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Even with the rapid development of pediatric postoperative pain management, pediatric patients have remained undertreated for postoperative pain because of difficulty in pain assessment and concerns regarding side effects of opioid analgesics. Although there are no perfect pain assessment techniques and no absolutely safe analgesics, proper monitoring and an individualized analgesic plan after due consideration of age, operative procedures, and underlying illness, using multimodal analgesics may improve the quality of pain control in children.

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Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine

Cited by 81 publications

References 15 publications

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

The Pharmacokinetics of Ketorolac After Single Postoperative Intranasal Administration in Adolescent Patients

Attention to postoperative pain control in children

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