Comparative effects of intravenous ketorolac and pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for paediatric strabismus surgery

Background: Corrective strabismus surgery is associated with moderate pain and a very high incidence of postoperative nausea and vomiting (PONV). Keto rolac tromethamine, a nonsteroidal anti-inflammatory drug, is a popular ana lgesic in adults. There are only limited published data on the use of intra venous ketorolac for paediatric analgesia perioperatively. This study evalu ated and compared the emetic and analgesic effect of ketorolac with pethidi ne and its suitability for this kind of surgery. Methods: Following institutional ethics committee approval and parental con sent, 52 ASA class I children of age 2.5 to 15 yr were randomised to receiv e either ketorolac 0.9 mg kg(-1) or pethidine 0.5 mg kg(-1) given intraveno usly (IV). A blinded observer assessed recovery by Steward's method immedia tely after arrival at the post anaesthesia care unit (PACU), pain by valida ted Objective Pain Score (OPS) at 0 h, 1/2 h and 1 h after arrival at the P ACU and PONV by Numeric Rank Score at specified time intervals. Results: There were no differences in demographic data, anaesthesia time or surgery duration. Recovery scores, OPS and postoperative analgesic require ment were similar in both groups. PONV at various time intervals for the fi rst 24 h, occurred more frequently in the pethidine group as compared to th e ketorolac group (P<0.001) There were no side effects observed with either drug. Conclusion: Ketorolac in a dose of 0.9 mg kg(-1) TV at the induction of ana esthesia is as effective as pethidine 0.5 mg kg(-1) IV as an analgesic and is associated with significantly less PONV.