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.
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.
Article PDF
Similar content being viewed by others
References
Berde CB. Pediatric postoperative pain management. Pediatr Clin North Am 1989; 36: 921–40.
Maunuksela E-L, Olkkola KT. Pediatric pain management. Int Anesthesiol Clin 1991; 29: 37–55.
Wall PD. The prevention of postoperative pain. Pain 1988; 33: 289–90.
Croteau N, Hai-Vu, Pless IB, Infante-Rivard C. Trends in medical visits and surgery for otitis media among children. Am J Dis Child 1990; 144: 535–8.
Orobello PW, Park RI, Wetzel RC, Belcher LJ, Naclerio RM. Phenol as an adjuvant anesthetic for tympanotomy tube insertion. Int J Pediatr Otorhinolaryngol 1991; 21: 51–8.
American Academy of Pediatrics, Committee on Drugs, Section of Anesthesiology. Guidelines for the elective use of conscious sedation, deep sedation and general anesthesia in pediatric patients. Pediatrics 1986; 77: 754.
Aldrete JA, Kroulik DA. Post anesthesia recovery score. Anesth Analg 1970; 49: 924–34.
McGrath PA. An assessment of children’s pain: a review of behavioural, physiological and direct scaling techniques. Pain 1987; 31: 147–76.
Hanallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and ilioinguinal/ iliohypogastric nerve blocks for the control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology 1987; 66: 832–5.
Norden J, Hannallah R, Getson P, et al. Concurrent validation of an objective pain scale for infants and children. Anesthesiology 1991; 75: A934.
Buckley MMT, Brogden RN. Ketorolac. A review of its pharmaco-dynamic and pharmaco-kinetic properties and its therapeutic potential. Drugs 1990; 39: 86–109.
McQuay HJ, Poppleton P, Carroll D, Summerfield RJ, Bullingham RES, Moore RA. Ketorolac and acetaminophen for orthopedic postoperative pain relief. Clin Pharmacol Ther 1986; 39: 89–93.
Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. Br J Anaesth 1991; 66: 703–12.
Dupuis R, Lemay H, Bushnelle MC, Duncan GH. Preoperative flurbiprofen in oral surgery: a method of choice in controlling postoperative pain. Pharmacotherapy 1988; 8: 193–200.
Olkkola KT, Maunuksela E-L. The pharmacokinetics of postoperative intravenous ketorolac in children. Br J Clin Pharmacol 1991; 31: 182–4.
Mroszczak E, Jung D, Yee J, et al. Ketorolac tromethamine pharmacokinetics and metabolism after intravenous, intramuscular and oral administration in humans and animals. Pharmacotherapy 1990; 10: 33S-39S.
Forbes JA, Kehm CJ, Grodin CD, Beaver WT. Evaluation of ketorolac, ibuprofen, acetaminophen, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy 1990; 10: 94S-105S.
Forbes JA, Butterworth GA, Burchfield WH, Beaver WT. Evaluation of ketorolac, aspirin and an acetaminophencodeine combination in postoperative oral surgery pain. Pharmacotherapy 1990; 10: 77S-93S.
Vengen O, Doessland S, Lindback E. Comparative study of ketorolac and paracetamol-codeine in alleviating pain following gynecological surgery. J Int Med Res 1988; 16: 433–51.
Sunshine A, Richman H, Cordone R, et al. Analgesic efficacy and onset of oral ketorolac in postoperative pain. Clin Pharmacol Ther 1988; 43: 159.
Goresky GV, Maltby JR. Editorial. Fasting guidelines for elective surgical patients. Can J Anaesth 1990; 37: 493–5.
Gaudreault P, Guay J, Nicol O, Dupuis C. Pharmacokinetics and clinical efficacy of intrarectal solution of acetaminophen. Can J Anaesth 1988; 35: 149–52.
Rumack BH. Aspirin versus acetaminophen: a comparative view. Pediatrics 1978; 62: 943–6.
Windofer A, Vogel C. Investigations concerning serum concentration and temperature following oral application of a new paracetamol preparation. Klin Paediatr 1976; 188:430–4.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Watcha, M.F., Ramirez-Ruiz, M., White, P.F. et al. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 39, 649–654 (1992). https://doi.org/10.1007/BF03008224
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03008224