Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls

Authors

Jason R. Stein, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Esperanza Mantilla-Rivas, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Marudeen Aivaz, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Md Sohel Rana, Joseph E. Robert, Jr., Center for Surgical Care, Children's National Hospital, Washington, DC, USA.
Ishwarya Shradha Mamidi, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Brynne A. Ichiuji, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Monica Manrique, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Gary F. Rogers, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
Julia C. Finkel, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Albert K. Oh, Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.

Document Type

Journal Article

Publication Date

4-1-2022

Journal

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association

Volume

59

Issue

4

DOI

10.1177/10556656211012864

Keywords

FLACC; NSAID; cleft lip; cleft palate; efficacy; ketorolac; pain; palatoplasty; safety

Abstract

OBJECTIVE: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). DESIGN: Consecutive cohort of patients undergoing PP, comparing to historical controls. A large academic children's hospital. PATIENTS, PARTICIPANTS: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). INTERVENTIONS: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. MAIN OUTCOME MEASURES: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. RESULTS: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( = .56). Significant postoperative hemorrhage was not observed. CONCLUSIONS: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.

APA Citation

Stein, Jason R.; Mantilla-Rivas, Esperanza; Aivaz, Marudeen; Rana, Md Sohel; Mamidi, Ishwarya Shradha; Ichiuji, Brynne A.; Manrique, Monica; Rogers, Gary F.; Finkel, Julia C.; and Oh, Albert K., "Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls" (2022). GW Authored Works. Paper 851.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/851

Department

Anesthesiology and Critical Care Medicine