Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy

Background : Tonsillectomy is a common procedure in childhood resulting in significant morbidity due to pain. The aim of this study was to evaluate the analgesic efficacy and safety of a single dose of ketorolac i.v. given before or after tonsillectomy, compared to placebo. Methods : A randomized, double‐blind, placebo‐controlled study was performed in 60 children, 5 to 15 years of age, admitted for tonsillectomy Patients were allocated to receive ketorolac 1 mg . kg ‐1 i.v. or placebo. Postoperative pain was assessed by self‐report 1.5, 3, 5, and 24 h after surgery. Results : Pain scores were significantly lower for both ketorolac groups compared to the placebo group 1.5, 3, and 5 h after surgery ( P <0.05). Pain scores were lowest in the preoperative ketorolac group 1.5 to 5 h after surgery, and significantly fewer children in this group had fentanyl 0 to 1.5 h after surgery. But no significant differences were found between pain scores of the preoperative and postoperative ketorolac groups in the first 24 h after surgery. Acetaminophen consumption during the first 5 h after surgery was significantly less in patients receiving ketorolac ( P <0.05). Patients in the preoperative ketorolac group had a significantly lower incidence of postoperative vomiting ( P <0.05). There were no significant differences in the incidence of postoperative bleeding between groups. Three children in the preoperative, 5 children in the postoperative ketorolac group, and 5 children in the placebo group experienced postoperative haemorrhage. Conclusion : This study indicates that a single dose of ketorolac 1 mg . kg ‐1 i.v. administered either before or immediately after surgery improves postoperative analgesia in children after tonsillectomy without evidence of increased incidence of bleeding.