A randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children

Objectives: To evaluate the efficacy of a single dose of ketorolac compared with morphine for the relief of pain in children, and to determine the safety of ketorolac, Setting: Tertiary pediatric intensive care unit in a university-affiliated hospital, Design: Prospective, randomized, double-blind, parallel, single-dose, positive control study, Patients: Children admitted to the intensive care unit with postoperative pain. Interventions: Patients received a single dose of either morphine or ketorolac as the first postoperative analgesic when the pain score indicated significant pain. Blood pressure, heart rate, and urine output were recorded, as well as blood urea nitrogen, creatinine, bleeding time, hematuria or proteinuria, and aspartate aminotransferase, Side effects such as nausea and vomiting were noted. Morphine was used for rescue treatment if the patient continued to have significant pain greater than or equal to 30 mins after study drug administration. Measurements and Main Results: Of the 102 children studied, 48 received morphine and 54 received ketorolac, The percentage of patients reporting pain relief in the first and second hours after drug administration was not different between groups. Likewise, the proportion of patients who met the criteria for pain relief during the entire evaluation period was not different between groups. There was a trend toward fewer patients who received ketorolac requiring remedication in the first 4 hrs compared with those who received morphine, but this trend did not reach statistical significance. More patients in the morphine group failed to achieve pain relief at any time after the dose compared with those who received ketorolac, There were no differences between the two groups in physiologic or laboratory variables. Vomiting was more common in patients who received ketorolac, Conclusion: Ketorolac is comparable to morphine in relief of postoperative pain in children. A single dose of ketorolac does not result in abnormal postoperative bleeding or alter renal function. However, ketorolac may cause nausea and vomiting in some patients.