TY - JOUR
T1 - Intraoperative ketorolac for pediatric tonsillectomy
T2 - Effect on post-tonsillectomy hemorrhage and perioperative analgesia
AU - Rabbani, Cyrus C.
AU - Pflum, Zachary E.
AU - Ye, Michael J.
AU - Gettelfinger, John D.
AU - Sadhasivam, Senthil
AU - Matt, Bruce H.
AU - Dahl, John P.
N1 - Funding Information:
The authors disclose no conflicts of interest and have no financial disclosures. We thank George Eckert, MAS (Department of Biostatistics; Indiana University-Purdue University; Indianapolis, IN) and Kathryn Whitlock (Clinical and Translational Research; Seattle Children's Hospital; Seattle, WA) for assistance with data analysis and statistical calculations as well as Ricardo Tuason, MHA, RN (Clinical Research Information Services; Indiana University Health; Indianapolis, IN) for assistance in the original patient search.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: Determine the impact of ketorolac on post-tonsillectomy hemorrhage (PTH) and narcotic administration in children undergoing tonsillectomy. Methods: Retrospective case series from 2013 to 2017. Patients younger than 18 years undergoing tonsillectomy were included. PTH was the primary outcome measured. Secondary measures include percentage of patients requiring surgical intervention for PTH, average time to PTH, the number of post-operative opioid doses, and average post-operative opioid dose. Statistical methods include Chi-square, Wilcoxon rank sum, and binary logistic regression analyses. Results: During the study period, 669 patients received a single intraoperative dose of ketorolac (K+) and 653 patients did not receive ketorolac (K-). No differences were found in the rate of PTH (K- 6.5% vs. K+ 5.3%, RR = 0.82, 95% CI = 0.53 to 1.29, p = 0.40), surgical control of PTH (K- 4.0% vs. K+ 3.5%, RR = 0.87, CI = 0.51 to 1.51, p = 0.62), or average time [SD] to PTH (K- 6.0 [4.2] vs. K+ 5.2 [4.9] days; difference = 0.8 days; 95% CI, −1.3 to 2.9; p = 0.45). K+ patients had fewer post-operative opioid doses [SD] (K- 1.86 [1.14] vs. K+ 1.59 [1.23]; difference = −0.27; 95% CI, −0.053 to −0.49, Cohen d = 0.23) and a lower average opioid dose [SD] (K- 0.041 [0.032] vs. K+ 0.035 [0.030] mg/kg; difference = −0.006 mg/kg; 95% CI, −0.0003 to −0.012; Cohen d = 0.19). Conclusion: Ketorolac did not increase risk of hemorrhage following tonsillectomy and decreased narcotic use.
AB - Objective: Determine the impact of ketorolac on post-tonsillectomy hemorrhage (PTH) and narcotic administration in children undergoing tonsillectomy. Methods: Retrospective case series from 2013 to 2017. Patients younger than 18 years undergoing tonsillectomy were included. PTH was the primary outcome measured. Secondary measures include percentage of patients requiring surgical intervention for PTH, average time to PTH, the number of post-operative opioid doses, and average post-operative opioid dose. Statistical methods include Chi-square, Wilcoxon rank sum, and binary logistic regression analyses. Results: During the study period, 669 patients received a single intraoperative dose of ketorolac (K+) and 653 patients did not receive ketorolac (K-). No differences were found in the rate of PTH (K- 6.5% vs. K+ 5.3%, RR = 0.82, 95% CI = 0.53 to 1.29, p = 0.40), surgical control of PTH (K- 4.0% vs. K+ 3.5%, RR = 0.87, CI = 0.51 to 1.51, p = 0.62), or average time [SD] to PTH (K- 6.0 [4.2] vs. K+ 5.2 [4.9] days; difference = 0.8 days; 95% CI, −1.3 to 2.9; p = 0.45). K+ patients had fewer post-operative opioid doses [SD] (K- 1.86 [1.14] vs. K+ 1.59 [1.23]; difference = −0.27; 95% CI, −0.053 to −0.49, Cohen d = 0.23) and a lower average opioid dose [SD] (K- 0.041 [0.032] vs. K+ 0.035 [0.030] mg/kg; difference = −0.006 mg/kg; 95% CI, −0.0003 to −0.012; Cohen d = 0.19). Conclusion: Ketorolac did not increase risk of hemorrhage following tonsillectomy and decreased narcotic use.
KW - Bleeding
KW - Ketorolac
KW - Pain
KW - Tonsillectomy
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U2 - 10.1016/j.ijporl.2020.110341
DO - 10.1016/j.ijporl.2020.110341
M3 - Article
C2 - 32891944
AN - SCOPUS:85090039548
SN - 0165-5876
VL - 138
JO - International Journal of Pediatric Otorhinolaryngology
JF - International Journal of Pediatric Otorhinolaryngology
M1 - 110341
ER -