Ketorolac after colectomy for ulcerative colitis in children: An analysis of opioid utilization and postoperative complications
| Autor: | Scott S. Short, Stephen L. Guthery, Mark Deneau, William B. West, Mark A. Taylor |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_treatment
Population Inflammatory bowel disease 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030225 pediatrics medicine Humans Child education Colectomy Retrospective Studies Pain Postoperative education.field_of_study business.industry Anti-Inflammatory Agents Non-Steroidal Acute kidney injury Retrospective cohort study General Medicine Perioperative medicine.disease Ulcerative colitis Analgesics Opioid body regions Ketorolac 030220 oncology & carcinogenesis Anesthesia Pediatrics Perinatology and Child Health Colitis Ulcerative Surgery business medicine.drug |
| Zdroj: | Journal of Pediatric Surgery. 55:2393-2396 |
| ISSN: | 0022-3468 |
| Popis: | Introduction Enhanced recovery protocols include multimodal perioperative pain control and frequently include use of NSAIDs. There is conflicting evidence that ketorolac use in inflammatory bowel disease (IBD) may precipitate disease flares and postoperative complications. The outcomes of children who receive ketorolac in this setting are not well known. We sought to evaluate ketorolac utilization in children following colectomy for ulcerative colitis. Methods All patients undergoing colectomy for ulcerative colitis between 2007 and 2017 at a tertiary children's hospital were reviewed. We collected patient age, duration of symptoms, operative details, medication utilization, length of stay, and postoperative complications. We performed a cohort comparison of these variables across patients who did vs. did not receive postoperative ketorolac. Results Sixty children were identified with median age at diagnosis of 12.6 years (IQR: 9.9–14.5). At colectomy, patients had a median PUCAI score of 60 (45–70), ESR 34 mm/h (15–50), hemoglobin 10.9 g/dL (9.3–12.9), and albumin 3.1 g/dL (2.4–3.8). Postoperatively, 45% (n = 27) received ketorolac. Patients in both cohorts had a similar length of stay, duration of opioid exposure, total morphine equivalents utilized, readmission rate, and unexpected return to the operating room. There were no documented cases of postoperative bleeding, acute kidney injury, or disease related flares among children receiving ketorolac. Conclusions Administration of ketorolac after colectomy in IBD was not associated with an increase in any postoperative complications, though the study was underpowered to detect these differences. However, ketorolac administration did not lead to a decreased utilization of opioid analgesia. Further prospective research is necessary to understand whether ketorolac in this population is safe and offers benefit. Type of study Retrospective study. Level of evidence III |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect