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The use of ketorolac may reduce opioid exposure in infants less than 6 months of age undergoing congenital heart surgery

Published online by Cambridge University Press:  17 April 2024

Janae Townsend ,
Hania Zaki ,
Rohali Keesari ,
Kevin Maher ,
Susan Hupp  and
Joshua W. Branstetter Open the ORCID record for Joshua W. Branstetter [Opens in a new window]
Janae Townsend
Affiliation:
Department of Pharmacy, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Hania Zaki
Affiliation:
Department of Pharmacy, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Rohali Keesari
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Kevin Maher
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA Children’s Healthcare of Atlanta Heart Center, Atlanta, GA, USA
Susan Hupp
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA Children’s Healthcare of Atlanta Heart Center, Atlanta, GA, USA
Joshua W. Branstetter*
Affiliation:
Department of Pharmacy, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Corresponding author: J. W. Branstetter; Email: joshua.branstetter@choa.org
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Abstract

Objectives:

Pain management for infants undergoing cardiothoracic surgery primarily utilises opioid analgesics. There is a paucity of data available for the use of non-steroidal anti-inflammatory medications such as ketorolac in this patient population.

Materials and Methods:

This retrospective study evaluated patients between 30 days and 6 months undergoing cardiothoracic surgery. The primary endpoint evaluates ketorolac on reducing post-operative opioid use.

Results:

Of 243 evaluated patient, 145 met inclusion. Baseline demographics were similar amongst the cohorts. Patients administered ketorolac used less cumulative opiates, in morphine milligram equivalents, for post-op days (POD) 1–3 after surgery compared to patients not receiving ketorolac (9.47 versus 12.68; p = 0.002). The no-ketorolac group required more opiates on POD 1 (10.9 versus 5; p < 0.001) and POD 2 (4.2 versus 2.5; p = 0.006) with no difference found on POD 3 (2 versus 1.6; p = 0.2). There was a mean increase from baseline to highest serum creatinine level on POD 1–3 in the no-ketorolac group compared to the ketorolac group (0.15 versus 0.09 mg/dL; p < 0.014), with no difference in stage 1 or stage 2 acute kidney injury. There were no differences in average chest tube output in mL/kg/day (0.24 versus 0.32; p = 0.569) or need for transfusion (36% versus 24%; p = 0.125), respectively.

Discussion:

Scheduled administration of ketorolac after cardiothoracic surgery resulted in a significant reduction in opioid exposure, with no difference in rates of acute kidney injury or bleeding.

Keywords

CHDsnon-steroidal anti-inflammatory drugsketorolaccardiologypaediatric
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 4
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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