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Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy

  • Mehernoor F. Watcha
  • Manuel Ramirez-Ruiz
  • Paul F. White
  • M. Barry Jones
  • Richard G. Lagueruela
  • Raghu P. Terkonda
Reports on Investigation

Abstract

Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a doubleblind, placebocontrolled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml · kg−1), acetaminophen (10 mg · kg−1) or ketorolac (1 mg · kg−1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.

Key words

anaesthesia: paediatrics analgesics: acetaminophen, ketorolac pain: postoperative 

Résumé

L’administration prophylactique d’analgésiques avant la chirurgie peut diminuer les besoins anesthésiques peropératoires et la douleur durant la période postopératoire immédiate. Quatrevingtdix enfants avec un état physique ASA I ou II devant subir une myringotomie bilatérale participent à cette étude à doubleinsu avec un groupe contrôleplacebo. Sont comparés les effets analgésiques postopératoires de l’acétaminophène et du kétoralac administrés par voie orale 30 minutes avant l’induction anesthésique. Les patients reçoivent au hasard soit de la solution saline (0.1 ml · kg−1), soit de l’acétaminophène (10 mg · kg−1), soit du kétoralac (1 mg · kg−1). Chacune des préparations est diluée dans un sirop à saveur de cerise pour faire un total de 5 ml. L’induction et l’entretien de l’anesthésie se font avec de l’halothane et du protoxyde d’azote administrés par masque. Un observateur non informé du médicament donné au patient évalue la douleur postoperatoire à l’aide d’une échelle de douleur objective. Les variables démographiques, la durée de l’anesthésie et de la chirurgie, le comportement à l’induction, la saturation artérielle en oxygène, l’incidence des vomissements postopératoires et le temps d’éveil sont comparables entre les trois groupes. Les patients du groupe kétoralac ont un pointage de douleur postopératoire plus bas que ceux des groupes acétaminophène et placebo, et Us nécessitent moins souvent un supplément analgésique. D’autre part, il n’ya pas de différence entre les groupes acétaminophène et placebo pour la douleur et les besoins analgésiques postopératoires. En conclusion, le kétoralac, mais pas l’acétaminophène, administré par la bouche avant la chirurgie assure une meilleure analgésie postopératoire qu’un placebo chez les enfants subissant une myringotomie bilatérale.

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Copyright information

© Canadian Anesthesiologists 1992

Authors and Affiliations

  • Mehernoor F. Watcha
    • 1
  • Manuel Ramirez-Ruiz
    • 1
  • Paul F. White
    • 1
  • M. Barry Jones
    • 1
  • Richard G. Lagueruela
    • 1
  • Raghu P. Terkonda
    • 1
  1. 1.Division of Clinical Research, Department of AnesthesiologyWashington University School of MedicineSt. Louis

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