Safety of ketorolac in surgical neonates and infants 0 to 3 months old

Use of Intravenous Ketorolac as Postoperative Analgesic in Neonates: A Prospective Study in Chittagong, Bangladesh

“…Bowel was moved in maximum patients in both groups, most patients passed their urine from the beginning of the operation. There are scarcity of published materials on postoperative ketorolac use in neonates, those available are mainly on children and those available on neonates express the similar findings as in this study 25,27 . According to Taddio et al (2000) both acetaminophen and ketorolac are safe drugs regarding cardiac activity, respiratory function and temperature regulation.…”

“…It is generally well tolerated, but the risk for bleeding and renal dysfunction must always be taken into consideration 24 . However, minimal safety data exist regarding the use of ketorolac in neonates 25 .…”

“…Other variables include: bleeding time, clotting time, skin color changes, and development of edema and bulging of fontanelle. Aldrink JH et al (2011) state that neonates of less than 21 days may have increased risk for bleeding after intravenous ketorolac 25 . However many other studies demonstrated that intravenous ketorolac is safe to use in neonates in regard to bleeding manifestations [27][28] .…”

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

“…The studies also failed to show a significant difference in the rate of adverse events between patients treated with ketorolac versus placebo although Aldrink et al (25) found an increased association between bleeding events in patients who received ketorolac and the lack of previous exposure to enteral feeds. Although the association was not statistically significant, this finding may be of clinical significance in a patient population that is likely to be on parenteral nutrition without the potentially protective effects of enteral feeds on the gastrointestinal system.…”

Enteral Docosahexaenoic Acid Reduces Analgesic Administration in Neonates Undergoing Cardiovascular Surgery

“…The most frequently used drugs are opioids and non-steroidal anti-inflammatory drugs such as fentanyl, morphine, buprenorphine, paracetamol and ketorolac [7][8][9][10] . Recognized side effects of opioids are hypotension, respiratory depression, prolonged ileus, ventilator dependence and depression of the immune system in a dose-dependent response [11,12] , whereas ketorolac may decrease platelet aggregation, increase bleeding events and cause renal insufficiency [9,13] . Thus, studies examining non-pharmacological strategies or ways to combine with other treatments or balance these treatments for neonatal patients to achieve optimal pain relief with less prolonged exposure are needed [4,14].…”