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Ketorolac combo curbs fentanyl need in pediatric hernia repair

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Giving ketorolac and acetaminophen during pediatric inguinal hernia repair reduces the need for postoperative opioids, Korean researchers report in the April issue of the Journal of Urology.

As senior author Dr. Hae Keum Kil told Reuters Health by email, co-administration of 1 mg/kg ketorolac and 20 mg/kg acetaminophen “provides efficient analgesia and fentanyl-sparing effect postoperatively in children undergoing ambulatory inguinal hernioplasty.”

Dr. Kil and colleagues at Yonsei University College of Medicine, Seoul, randomized 55 children, ages 1 to 5, to receive either ketorolac and acetaminophen intravenously, or placebo, after induction of anesthesia. All received 1 mcg/kg of fentanyl before incision.

Eight children (28.6%) in the treated group and 22 (81.5%) in the control group required more than one dose of fentanyl in the recovery ward. Two treated children and 11 controls required more than two doses (7.1% vs 40.7%).

The control group received a larger total dose of fentanyl and had higher rates of sedation (55.6% vs 25.0%) and vomiting (33.3% vs 10.7%) than the combination group.

“A single preoperative intravenous administration of ketorolac and acetaminophen is a simple, safe and effective method for relieving pediatric postoperative pain, and demonstrates highly significant fentanyl-sparing effects,” the investigators conclude.


J Urol 2010;183:1551-1555.