Acetaminophen or ketorolac for post myringotomy pain in children? A prospective, double-blinded comparison

Myringotomy with tube placement (BMT) is the most frequent surgical procedure performed in children. The purpose of this prospective, double-blinded study was to determine if 15 mg.kg(-1) of acetaminophen (paracetamol) provides analgesia similar to that provided by ketorolac, 1 mg.kg(-1), at a lower cost. One-hundred-and-thirty-two children, ages six months to nine years, scheduled for elective BMT were randomized to receive oral acetaminophen or ketorolac 30 min preoperatively. An Objective Pain Scale* score was assessed upon arrival to the PACU and at five, ten and 20 min. Time of awakening, time of PACU and day surgery discharge and incidence of vomiting were recorded. Groups were comparable in demographics, side effects and time to discharge. Median pain scores were lower in the ketorolac group at five and ten min but no differences were seen at discharge nor in postdischarge analgesic requirements. Is ten min of better analgesia worth the cost of ketorolac? We conclude that the slight analgesic benefit from ketorolac does not justify its cost in this setting.