Journal of Isfahan Medical School

Journal of Isfahan Medical School

A Comparative Study of the Analgesic Effects of Pethidine versus Ketorolac and Acetaminophen after Lower Abdominal and Genital Surgeries in Children

Document Type : Original Article (s)

Authors
Hamid Saryazdi 1
Omid Aghadavoudi 1
Amir Shafa 2
Mohammad Baghban-Nikoo 3
Tahereh Rezaei 4
1 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Nurse, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: For postoperative pain control, numerous methods and medications have been suggested, such as non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics. Pethidine, as a narcotic analgesic, and ketorolac as an NSAID and acetaminophen, are widely used for pain control. In this study, the effect of ketorolac and acetaminophen on postoperative pain was compared with pethidine in the lower abdominal and genital surgeries in children.Methods: In a double-blind randomized clinical trial study, 64 children undergoing lower abdominal and genital surgeries were selected and randomly divided into 2 groups. At the end of the surgery and before extubation, the first group received 10-15 mg/kg acetaminophen suppository and 0.5 mg/kg intravenous ketorolac and the second group received 1 mg/kg intravenous pethidine. Postoperative pain [using Objective pain scale (OPS)] and complications were evaluated and compared until 24 hours after the surgery.Findings: Postoperative pain relief was similar in the two groups up to half an hour (OPS of 5.38 ± 1.93 vs. 5.44 ± 2.04); but, from 1 to 24 hours postoperatively, pain scores were significantly higher in the pethidine group (P < 0.05). In addition, the occurrence of nausea and vomiting was similar in both groups (P > 0.05). No other complication was observed in the patients.Conclusion: Ketorolac and acetaminophen are two frequently used non-opioid analgesics that may be used in combination for effective pain control after surgical procedures in children.
Keywords
Ketorolac
Acetaminophen
Meperidine
Analgesics
Child
  1. Baley K, Michalov K, Kossick MA, McDowell M. Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review. AANA J 2014; 82(1): 53-64.
  2. Hong JY, Won HS, Kim WO, Kil HK. Fentanyl sparing effects of combined ketorolac and acetaminophen for outpatient inguinal hernia repair in children. J Urol 2010; 183(4): 1551-5.
  3. Smith HS. Perioperative intravenous acetaminophen and NSAIDs. Pain Med 2011; 12(6): 961-81.
  4. Aghadavoudi O, Saryazdi HH, Shafa A, Ramezani A. Comparison of pre-emptive effect of meloxicam and celecoxcib on post-operative analgesia: a double-blind, randomized clinical trial. Middle East J Anaesthesiol 2015; 23(3): 289-94.
  5. El Deeb A, El-Morsy GZ. Comparison of preemptive analgesic effect of intravenous ketorolac versus tramadol in pediatric inguinal herniotomy: a randomized double blind study. Egypt J Anaesth 2011; 27(4): 207-11.
  6. Hong JY, Kim WO, Koo BN, Cho JS, Suk EH, Kil HK. Fentanyl-sparing effect of acetaminophen as a mixture of fentanyl in intravenous parent-/nurse-controlled analgesia after pediatric ureteroneocystostomy. Anesthesiology 2010; 113(3): 672-7.
  7. Sutters KA, Shaw BA, Gerardi JA, Hebert D. Comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery. Am J Orthop (Belle Mead NJ) 1999; 28(6): 351-8.
  8. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth 2002; 88(2): 215-26.
  9. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002; 88(2): 199-214.
  10. Hiller A, Meretoja OA, Korpela R, Piiparinen S, Taivainen T. The analgesic efficacy of acetaminophen, ketoprofen, or their combination for pediatric surgical patients having soft tissue or orthopedic procedures. Anesth Analg 2006; 102(5): 1365-71.
  11. Morton NS, O'Brien K. Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine. Br J Anaesth 1999; 82(5): 715-7.
  12. Pickering AE, Bridge HS, Nolan J, Stoddart PA. Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 2002; 88(1): 72-7.
  13. Saryazdi HH, Aghadavoudi O, Shafa A, Masoumi A, Saberian P. A comparative study of the analgesic effect of intravenous pethidine vs. ketorolac after inguinal hernia surgery in children under general anesthesia. Middle East J Anaesthesiol 2016; 23(5): 527-33.
  14. Lee SY, Lee WH, Lee EH, Han KC, Ko YK. The effects of paracetamol, ketorolac, and paracetamol plus morphine on pain control after thyroidectomy. Korean J Pain 2010; 23(2): 124-30.
  15. Korpela R, Korvenoja P, Meretoja OA. Morphine-sparing effect of acetaminophen in pediatric day-case surgery. Anesthesiology 1999; 91(2): 442-7.
  16. Vetter TR, Heiner EJ. Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine. J Clin Anesth 1994; 6(2): 110-3.
  17. Viitanen H, Tuominen N, Vaaraniemi H, Nikanne E, Annila P. Analgesic efficacy of rectal acetaminophen and ibuprofen alone or in combination for paediatric day-case adenoidectomy. Br J Anaesth 2003; 91(3): 363-7.
  18. Munro HM, Riegger LQ, Reynolds PI, Wilton NC, Lewis IH. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery. Br J Anaesth 1994; 72(6): 624-8.
  19. McCormack K. Non-steroidal anti-inflammatory drugs and spinal nociceptive processing. Pain 1994; 59(1): 9-43.
  20. Rusy LM, Houck CS, Sullivan LJ, Ohlms LA, Jones DT, McGill TJ, et al. A double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding. Anesth Analg 1995; 80(2): 226-9.
  21. Bean-Lijewski JD, Hunt RD. Effect of ketorolac on bleeding time and postoperative pain in children: a double-blind, placebo-controlled comparison with meperidine. J Clin Anesth 1996; 8(1): 25-30.
  22. Reinhart DJ, Latson TW, Whitten CW, Klein KW, Allison PM, Patel M. Influence of ketorolac tromethamine on clot elastic strength in humans as assessed by thromboelastography. J Clin Anesth 1993; 5(3): 216-20.
Journal of Isfahan Medical School
Volume 34, Issue 412 - Serial Number 412
November and December 2017
Pages 1556-1562

  • Receive Date 09 October 2016
  • Accept Date 06 April 2022