Reevaluating Single-Dose Ketorolac for Primary Palatoplasty Postoperative Pain Management

Abstract

Objective

To evaluate the safety of immediate postoperative single-dose ketorolac after primary palatoplasty (PP) and assess its efficacy in reducing opioid use and improving other recovery metrics.

Design

Prospective cohort with historical controls.

Setting

Tertiary pediatric hospital.

Patients, Participants

Two hundred forty-nine patients who underwent PP between 2009 and 2023.

Interventions

Following institutional implementation of routine ketorolac use after PP, 124 patients who received an immediate postoperative single dose of IV ketorolac (median 0.5 mg/kg) were compared with 125 patients who did not receive ketorolac.

Main Outcome Measures

Safety outcomes included significant bleeding, supplemental oxygen requirements, and 30-day postoperative complications. Efficacy outcomes were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, postoperative opioid use, time to first oral intake, and antiemetic use.

Results

No significant differences were observed between groups regarding the minimal rates of postoperative bleeding, need for supplemental oxygen, or other adverse events. Postoperative FLACC scale was significantly lower in the ketorolac group during the first postoperative hour (adjusted difference: 0.54, 95% CI: 0.04-1.03, P = .033) and hours 1 to 3 (adjusted difference: 0.44, 95% CI: 0.02-0.85, P = .039). The ketorolac group also had lower total opioid use during hospitalization, earlier initiation of oral intake, and shorter length of stay, though these differences were not significant after multivariable adjustment.

Conclusions

Immediate postoperative single-dose ketorolac after PP is associated with improved early postoperative pain control without increasing complication rates. Other observed potential benefits deserve further attention.