Ketorolac suppresses postoperative bladder spasms after pediatric ureteralreimplantation

We evaluated the efficacy of ketorolac in suppressing postoperative bladder spasms after ureteroneocystostomy (ureteral reimplantation). Twenty-four p ediatric patients undergoing intravesical ureteroneocystostomy were enrolle d prospectively to receive either ketorolac or placebo via double-blinded r andomization. Twelve patients in each group shared similar preoperative cha racteristics. All were maintained on an epidural infusion of bupivacaine (0 .1%) with fentanyl (2 mu g/mL) throughout the study: Patients were given ei ther ketorolac (0.5 mg . kg(-1) . dose(-1)) or placebo (equivalent volume s aline) IV after surgery and every 6 h thereafter for 48 h. Parents were ins tructed to record bladder spasm episodes prospectively by using a standardi zed time-flow diary. Three patients (25%) in the ketorolac group experience d bladder spasms, compared with 10 patients (83%) in the placebo group (two -sided P < 0.05). The median severity score for the ketorolac group was 1.2 (mild = 1.0, severe = 3.0), compared with 2.6 for the placebo group (P = 0 .003). We conclude that IV ketorolac reduces the frequency and severity of postoperative bladder spasms after intravesical ureteroneocystostomy.