Assessment of safety of ketorolac in postsurgical infants

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Created On: 29/06/2022

A retrospective review was performed to analyze the occurrence of major bleed in postsurgical infants and neonates treated with ketorolac, and to describe features of ketorolac therapy and its impact on renal functionality.

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Key take away

In post-surgical infants younger than six months of age without coagulation and/or renal malfunction, the use of ketorolac seems to be associated with a reduced occurrence of major bleeds.

Background

Method

Overall, 125 postsurgical infants with postnatal age of 3.8 months, gestational age of 37.2 weeks, and mean dosing weight of 5.6 kg, and who were given ketorolac for postsurgery pain during the study were recruited. Major bleed was characterized as a reduction in hemoglobin by >2 g/dL in the 24 hours and/or pulmonary, gastrointestinal, intraventricular, or intracranial hemorrhage. Based on the criteria of per pediatric-modified RIFLE (risk, injury, failure, loss, end-stage renal disease), identification of renal impairment was done.

Result

Most commonly, ketorolac was administered as 0.5 mg/kg intravenously every six hours with a mean of 6.7 doses. Major bleed (key outcome) eventuated in 1.6% (n = 2) of 2-month-old infants of 39 weeks gestation. Both bleeds were defined by a reduction in hemoglobin without proof of clinically significant bleeding. A decrease in glomerular filtration rate and urine output was observed in 0.8% (n = 1) and 2.4% (n = 3) people. A concurrent medication linked with reduced bleeding risk was received by 49.6% (n = 62) of patients.

Conclusion

Ketorolac seems to exhibit reduced occurrence of major bleeds in postsurgical patients (aged less than six months) without coagulation and/or renal dysfunction.