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American Association of Plastic Surgeons

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Efficacy And Safety Of Single-dose Ketorolac In Primary Palatoplasty: A Prospective Analysis
Jason R. Stein, BS, Esperanza Mantilla-Rivas, MD, Marudeen Aivaz, B.S., Ishwarya S. Mamidi, B.S., Brynne A. Ichiuji, B.S., Md Sohel Rana, M.B.B.S., M.P.H., Monica Manrique, M.D., Justin R. Bryant, D.O., Monica Shah, MD, Gary F. Rogers, M.D., J.D., LL.M., M.B.A., M.P.H., Albert K. Oh, M.D..
Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.

PURPOSE:Optimal postoperative pain management after primary palatoplasty (PP) remains unclear. Ketorolac has demonstrated efficacy comparable to opioids with minimal adverse effects. Nevertheless, concerns regarding postoperative bleeding restrict its use. This prospective study examines the efficacy and safety of single-dose ketorolac for postoperative pain control in PP.
METHODS: We prospectively studied a consecutive cohort of patients undergoing PP. Subjects were classified into two groups: Group 1 was treated with standard doses of acetaminophen and narcotics while Group 2 received an additional single dose of ketorolac. Efficacy of ketorolac was assessed through numerous outcomes including bleeding and FLACC pain score using multivariable linear regression.
RESULTS 107 patients were included (Group 1 n=69; Group 2 n=38). There was no significant difference between median length of stay (LOS) for both groups (p=0.79). Nine patients received postoperative blow-by O2, 6 (8.7%) from Group 1 and 3 from Group 2 (7.9%; p=1). First FLACC score was significantly lower in Group 2 (p=0.04) although six-hour and LOS FLACC scores were not statistically different. The mean dose of opioid rescue medication measured as morphine milligram equivalents (MME) for hydromorphone, fentanyl, and oxycodone was lower in Group 2 (p=0.031). Significant postoperative hemorrhage was not observed in either group.
CONCLUSION: This is the first prospective study to demonstrate that a single dose of immediate postoperative ketorolac after PP provides effective analgesia without increasing the risk of postoperative hemorrhage, while significantly reducing the use of opioid medications. Use of perioperative ketorolac should be considered in PP.


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