The effect of intravenous ketoprofen on postoperative epidural sufentanil analgesia in children

We compared the effect of IV ketoprofen and placebo as an adjuvant to epidu ral sufentanil analgesia after major surgery. We used a prospective, random ized, double-blinded, placebo-controlled, parallel-group study design in 54 children aged 1-15 yr who received a standardized anesthetic. Either IV ke toprofen or saline was administered in addition to an epidural sufentanil i nfusion, which was adjusted as required clinically. The study drug infusion s were discontinued when pain scores were <3 on 0-10 scale for 6 h at a suf entanil infusion rate of 0.03 mu g.kg(-1).h(-1). Children in the ketoprofen group had a better analgesic effect, as shown by decreased need for sufent anil (mean [10th-90th percentiles] 8.3 [3.1-15.1] mu g/kg vs 12.5 [6.2-18.9 ] mu g/kg; P = 0.002) and earlier possibility to discontinuation of the epi dural sufentanil(ll [46%] vs 3 [13%]; P = 0.014) before the end of the 72-h study period. In the ketoprofen group, median (range) pain scores were low er during activity at 24 h (2 [0-5] vs 5 [0-7]; P = 0.01) and at 72 h (0 [0 -3] vs 2 [0-6]; P = 0.033), and fewer children had inadequate pain relief d uring activity at 24 h (0 vs 5; P = 0.037). Children who received ketoprofe n required fewer infusion rate adjustments (12 [ 4-20] vs 17 [6-42]; P = 0. 016). In the ketoprofen group, the incidence of desaturation (1 [ 4%] vs 6 [26%]; P = 0.035) and fever (3 [12%] vs 11 [48%]; P = 0.008) was less than that in the placebo group. We conclude that ketoprofen improved postoperati ve pain in children. Implications: We compared the effect of the IV nonster oidal antiinflammatory drug ketoyrofen versus placebo as adjuvants to epidu ral opioid analgesia with sufentanil. The continuous IV nonsteroidal antiin flammatory drug improved pain after major surgery in children receiving an epidural opioid. Although ketoprofen reduced epidural sufentanil requiremen ts, the incidence of opioid-related adverse effects was not changed.