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Ketorolac or fentanyl continuous infusion for post-operative analgesia in children undergoing ureteroneocystostomy

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Abstract:

Background:

Children undergoing ureteroneocystostomy suffer from post-operative pain due to the surgical incision and bladder spasm. A single-shot caudal block is a common technique for paediatric analgesia, but a disadvantage is the limitation of a short duration in spite of the additives co-administered. A few clinical trials have shown that ketorolac provides an effective post-operative analgesia and reduces the bladder spasms after ureteral implantation in children. We compared the efficacy of a continuous infusion of ketorolac and fentanyl in post-operative analgesia and bladder spasm in children who underwent ureteroneocystostomy. Methods:

Fifty-two children were allocated to the ketorolac group (Group K, n=26) and fentanyl group (Group F, n=26). After general anaesthesia, a caudal block was performed with 1.5 ml/kg of 0.15% ropivacaine. At the beginning of surgery, an infusion was started after the bolus injection of ketorolac 0.5 mg/kg or fentanyl 1 g/kg. An infusion device was programmed to deliver ketorolac 83.3 g/kg/h or fentanyl 0.17 g/kg/h for 48 h. Results:

Two of Group F and three of Group K were excluded from the study. Post-operative pain scores were similar between the two groups. One of Group K (4%) and seven of Group F (30.4%) experienced bladder spasms. The rescue analgesic requirements were significantly less in Group K. Conclusions:

A Continuous infusion of ketorolac provided effective analgesia after operation in children who underwent ureteroneocystostomy as well as a low dosage of fentanyl. Ketorolac was more effective in reducing the frequency of bladder spasms and rescue analgesic requirements.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2010.02354.x

Affiliations: Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea

Publication date: January 1, 2011

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