Safety of ketorolac in the pediatric population after ureteroneocystostomy

Purpose: Ketorolac has been used to provide effective postoperative analges ia in children and decreases hospitalization for pediatric patients undergo ing ureteroneocystostomy. However, it can cause severe side effects, includ ing increased bleeding and renal insufficiency, which can be devastating in a child. Little has been reported on the safety of ketorolac by evaluating creatinine, hematocrit and complications. Materials and Methods: An institutional retrospective review was performed during an 18-month period in which 118 patients underwent ureteroneocystost omy. One group containing 50 patients received caudal anesthetic preoperati vely and narcotic analgesics postoperatively, while another 68 received cau dal anesthetic preoperatively and ketorolac postoperatively. Patient ages, type of procedure, preoperative and postoperative creatinine and hematocrit , and complications were noted in each cohort. Results: Average patient age of the control analgesic and ketorolac groups was 5.3 years (range 1 to 17) and 5.5 (1 to 12), respectively. There was no statistical difference between postoperative creatinine (0.68 and 0.65 mg. /dl.) and hematocrit (33% and 34%) between the groups. One patient in each group had increased creatinine postoperatively. Minor complications, for ex ample ileus and bladder spasms, were equivalent in both groups. No patient receiving ketorolac had any allergic or hypersensitivity reaction to the me dication, and no major complications were reported. Conclusions: Ketorolac given after ureteroneocystostomy did not cause a sig nificant decrease in hematocrit, increase in creatinine or overall complica tions. Because of the safety of ketorolac in our series, and ability to dec rease hospital stay and narcotic requirements in children as reported previ ously, it is used as standard postoperative protocol after ureteroneocystos tomy at our institution.