A DOUBLE-BLIND EVALUATION OF KETOROLAC TROMETHAMINE VERSUS ACETAMINOPHEN IN PEDIATRIC TONSILLECTOMY - ANALGESIA AND BLEEDING

The study was designed to compare intravenous ketorolac to rectal acet aminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsill ectomy with or without adenoidectomy. In a randomized, prospective dou ble-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). Bleeding was evaluated b y measuring intraoperative blood loss and noting extra measures requir ed to obtain hemostasis. Bleeding times were also measured before and during surgery. Pain was evaluated using a standard objective pain sco re for the first 3 h. Persistent pain was treated with morphine, aceta minophen, and codeine and recorded for 24 h. Blood for determination o f acetaminophen levels was drawn at 20 and 40 min after the administra tion of study drugs. Pain scores were not significantly different betw een the ketorolac and acetaminophen groups. The majority of patients i n both groups required additional opioid in the postoperative period. Acetaminophen levels were all less than the therapeutic range. Intraop erative bleeding times were normal in all patients, but blood loss was significantly higher in the ketorolac group (2.67 mL/kg) compared to the acetaminophen group (1.44 mL/kg), P = 0.025. Significantly more me asures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dos e rectal acetaminophen for analgesia in the patient undergoing tonsill ectomy. Hemostasis during tonsillectomy was significantly more difficu lt to achieve in patients receiving ketorolac.