[Analgesic efficacy of ketorolac and fentanyl in pediatric intensive care]

Abstract

Objective: To evaluate the efficacy of the two different drugs (Ketorolac and Fentanyl), used singularly or in association, in the management of postoperative pain in Picu.

Study design: A randomized and prospective study.

Methods: 52 children were randomly assigned to receive intravenous Ketorolac and/or Fentanyl, according to four different analgesic treatments: A) Ketorolac 1.2 mg/kg every six hrs; B) Ketorolac 1.2 mg/kg (bolus) + 0.21 mg/ kg/hr; C) Fentanyl 1 gamma/kg/hr; D) Fentanyl 1 gamma/kg/hr + Ketorolac 0.21 mg/kg/hr. Each protocol was given to 13 children. The efficacy of treatments were evaluated by child's behaviour (Affective Facial Scale and CHEOPS score) and hemodynamical parameters (systolic and diastolic blood pressure, breathing rate, heart rate, oxygen saturation and oxygen arterial pressure) and analysed by statistical analysis.

Results: The children treated with protocol B (Ketorolac in continuous in infusion) showed better pain relief in respect to those treated with protocol A (Ketorolac in bolus), while the most efficient analgesia was obtained with the association of the two analgesic drugs (protocol D). Two cases of bradycardia, one case of hyperazotemia and one case of transaminase increase were noted.

Conclusion: Ketorolac presents a good efficient analgesia, particularly evident when administered in continuous intravenous infusion. However, the association of this NSAID with an opioid drug can be favourably proposed in postoperative pain therapy of moderate to severe grade, since the confirmed analgesic efficacy is not aggravated by important side effects.