Postoperative Ketorolac Administration Is Not Associated with Hemorrhage in Cranial Vault Remodeling for Craniosynostosis

Tuncer, Fatma Betül; Knackstedt, Rebecca; Murthy, Ananth S.; Patel, Niyant

doi:10.1097/gox.0000000000002401

Cited by 8 publications

(14 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As we have demonstrated previously, ketorolac is a safe medication in this population, and does not increase risk of bleeding or blood transfusions, and reduces the need for opioids. 28 Children treated with the ERAS protocol required less morphine/dilaudid and oral narcotics. Thus, this demonstrates the success of our perioperative protocol to provide opioid-sparing pain control.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

Knackstedt

Patel

2020

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background: Enhanced recovery after surgery (ERAS) protocols utilize multi-modal approaches to decrease morbidity, narcotic usage, and length of stay. In 2013, we made several changes to our perioperative approach to children undergoing complex craniofacial procedures. The goal of this study was to analyze our protocol for children undergoing fronto-orbital advancement (FOA) for craniosynostosis. Methods: A retrospective chart review was performed after IRB approval, for children who underwent fronto-orbital advancement for craniosynostosis from 2010 to 2018. The ERAS protocol, initiated in December 2013, involves hemoglobin optimization, cell-saver technology, tranexamic acid, specific postoperative fluid titration, and a transfusion algorithm. The analgesic regimen focuses on narcotic reduction through the utilization of scheduled acetaminophen, ibuprofen, or ketorolac, and a dexmedetomidine infusion with opioids only for breakthrough pain. Results: Fifty-five ERAS protocol children and 23 control children were analyzed. ERAS children had a decreased rate (13/53 versus 23/23, P < 0.0001) and volume of intraoperative transfusion (183.4 mL versus 339.8 mL, P = 0.05). Fewer ERAS children required morphine/dilaudid (12/55 versus 22/23 P < 0.0001) and for children who required morphine, fewer doses were required (2.8 versus 11, P = 0.02). For ERAS protocol children who required PO narcotics, fewer doses were required (3.2 versus 5.3, P = 0.02). ERAS children had a decreased length of stay (2.3 versus 3.6 nights, P < 0.0001). No patients were re-admitted due to poor oral intake, pain, hemodynamic, or pulmonary concerns. Conclusions: Our ERAS protocol demonstrated a reduction in the overall and intraoperative allogenic blood transfusion rate, narcotic use, and hospital length of stay. This is a safe and effective multimodal approach to managing complex craniofacial surgical recovery.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The decision to give one over the other is at nursing discretion, as there is not a concern for postoperative hemorrhage. 28 Oxycodone and morphine are available and are given as needed at nursing discretion. Decision on which pain medication to utilize is nurse-driven and based on protocol parameters.…”

Section: Methodsmentioning

confidence: 99%

Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

Knackstedt

Patel

2020

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…Based on the previously defined exclusion criteria, only 16 articles published between 2000 and 2022 were included (Fig. 1 ) [ 2 , 10 , 14 , 27 – 39 ]. A total of 18 articles were excluded for the following reasons: improper methods (meta-analysis/systematic review, case reports) n = 4, reported no outcomes of interest ( n = 4), no full text was found ( n = 2), non-craniosynostosis patients ( n = 2), and incomplete description of perioperative pain management protocol ( n = 6).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 441 (52%) patients were included in seven articles describing the complete intraoperative analgesic protocol [ 14 , 32 , 34 , 36 , 38 , 39 ]. Reddy et al reported eighty patients were placed into one of two groups, with 39 receiving intraoperative dexmedetomidine and 41 who did not.…”

Section: Resultsmentioning

confidence: 99%

The management of perioperative pain in craniosynostosis repair: a systematic literature review of the current practices and guidelines for the future

Mortada

AlKhashan

Alhindi

et al. 2022

Maxillofac Plast Reconstr Surg

View full text Add to dashboard Cite

Background Craniosynostosis is a condition characterized by a premature fusion of one or more cranial sutures. The surgical repair of craniosynostosis causes significant pain for the child. A key focus of craniosynostosis repair is developing effective strategies to manage perioperative pain. This study aimed to review perioperative pain control strategies for craniosynostosis repair systematically. Methods Guidelines for reporting systematic reviews and meta-analyses were used in the design of this review. In May 2022, the following databases were used to conduct the literature search: MEDLINE, Cochrane, EMBASE, and Google Scholar. A search was performed using MeSH terms “craniosynostosis,” “pain management,” and “cranioplasty.” Results The literature review yielded 718 publications. After applying our inclusion criteria, 17 articles were included, accounting for a total of 893 patients. During the postoperative period, most studies used multimodal analgesia, primarily opioids, and acetaminophen. In the postoperative period, oral ibuprofen was the most commonly used NSAID, rectal codeine, and acetaminophen were the most commonly used weak opioids, and continuous remifentanil infusion was the most commonly used potent opioid. Conclusion The authors determined the best pain management options for pediatric patients undergoing cranioplasty by analyzing the most commonly used analgesics. A high-quality clinical trial comparing different types of analgesic combinations would be a valuable addition to the present literature.

show abstract

“…As a first-generation non-steroidal anti-inflammatory drug (NSAID), Ketorolac exerts its actions by blocking the prostaglandin synthesis by inhibiting the cyclooxygenase enzyme ( 22 , 23 ). The role of NSAIDs in controlling postoperative pain after LC has been studied in several studies.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

et al. 2021

View full text Add to dashboard Cite

Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects. Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC. Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant. Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001). Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

show abstract

Postoperative Ketorolac Administration Is Not Associated with Hemorrhage in Cranial Vault Remodeling for Craniosynostosis

Cited by 8 publications

References 42 publications

Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

Enhanced Recovery Protocol after Fronto-orbital Advancement Reduces Transfusions, Narcotic Usage, and Length of Stay

The management of perioperative pain in craniosynostosis repair: a systematic literature review of the current practices and guidelines for the future

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

Contact Info

Product

Resources

About