Safety and Efficacy of Ketorolac in the Management of Pain for Postoperative Pediatric General Surgery Patients

PurposeKetorolac is commonly cautioned with a possible effect of bleeding. The safety and efficacy of Ketorolac has not been examined in children who have undergone general surgery procedures.MethodsA single institution retrospective cohort study examining children ages 0-18 from 2017-2022 with and without Ketorolac <24 hours after the following operations: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic or open inguinal hernia repair, umbilical hernia repair, and ventral hernia repair. Demographics were reported using bivariate inferential statistics. A Cox proportional hazards model identified associations between Ketorolac and time to pain score ≤3. Logistic regression measured odds of opioid use in morphine equivalents 24-hour after surgery.Results5455 patients were identified. Children who received Ketorolac after surgery were more likely to be older (11.5 vs 7.0 years, <i>P</i> < .0001). Compared to Whites, Asian Americans (OR .50, CI .36-.63, <i>P</i> < .0001) and African Americans (OR .22, CI .13-.37, <i>P</i> < .0001) were less likely to receive Ketorolac. Patients receiving Ketorolac were more likely to have a high pain score (>5) after surgery (40% vs 23%, <i>P</i> < .0001) when receiving Ketorolac vs opioid alone (<i>P</i> < .0001). Patients receiving Ketorolac had 40% decreased odds of receiving opioid after surgery (OR .90, 95% CI: .87-.94, <i>P</i> < .0001). Blood transfusions were less common in patients that received Ketorolac (0.2% vs 0.7%, <i>P</i> = 0.005).ConclusionKetorolac does not increase the risk of bleeding requiring transfusion and decreases opioid administration. Ketorolac is efficacious in this patient population either alone or in combination with opioids and improves pain control compared to opioids alone.