57. Single-dose Ketorolac for Primary Palatoplasty Postoperative Pain Management: Safety and Efficacy Compared To Opioids

PURPOSE: Primary palatoplasty (PP) carries risks of postoperative pain, hemorrhage, and airway compromise. While intravenous opioids effectively reduce pain, the risks of respiratory depression, nausea, and vomiting led to a 2016 FDA warning against their use in pediatric populations. Ketorolac has demonstrated comparable analgesic efficacy to opioids without these adverse effects, though concerns remain about its potential to increase perioperative bleeding. This study builds on our previously published findings in a larger cohort. METHODS: This prospective study included 297 patients undergoing PP from 2009 to 2023. After implementing routine ketorolac use at our institution, 129 patients receiving immediate postoperative ketorolac (median dose 0.5 mg/kg) were compared to 150 prior patients who did not. Safety outcomes included significant bleeding, supplemental oxygen requirement, and 30-day postoperative complications. Efficacy was assessed using the FLACC scale, postoperative opioid use, and time to first PO intake. Statistical analysis utilized Wilcoxon-Mann-Whitney and Chi-square tests, with multivariate analysis adjusting for potential confounders. RESULTS: Postoperative FLACC pain scores were significantly lower in the ketorolac group during the first postoperative hour (adjusted difference: -0.61, 95% CI: -1.07 to -0.16, P = 0.009). The ketorolac group also had lower total opioid use during the entire hospitalization, earlier PO intake, and a shorter length of stay, though these differences did not reach statistical significance. No significant differences were observed in postoperative bleeding or the need for supplemental oxygen between groups. CONCLUSION: Immediate postoperative single-dose ketorolac after PP results in improved early postoperative pain control without increased complications.