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

• Published in: Cardiology in the young 2024-08, Vol.34 (8), p.1805-1808
• Main Authors: Townsend, Janae, Zaki, Hania, Keesari, Rohali, Maher, Kevin, Hupp, Susan, Branstetter, Joshua W.
• Format: Article
• Language: English
• Subjects: Analgesics; Analgesics, Opioid - therapeutic use; Anesthesia; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Cardiac Surgical Procedures - adverse effects; Creatinine; Demographics; Drug dosages; Female; Gestational age; Heart Defects, Congenital - surgery; Heart surgery; Humans; Infant; Infant, Newborn; Infants; Intensive Care; Ketorolac - administration & dosage; Ketorolac - adverse effects; Ketorolac - therapeutic use; Kidneys; Male; Morphine; Narcotics; Opioids; Original Article; Pain; Pain Management - methods; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Pediatrics; Population studies; Retrospective Studies; Surgeons; Surgery; Thoracic surgery
• ISSN: 1047-9511; 1467-1107; 1467-1107
• DOI: 10.1017/S104795112400091X

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. 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. 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. 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.