(Screen 4 - 5:45 PM Saturday) Multi-modal Analgesia with Ketorolac after Pediatric Cardiac Surgery Reduces Opioid PCA Exposure: A Single Center Experience

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Abstract:

Purpose: Pain management remains an important factor in the patients’ rate of rehabilitation, hospital course, and patient satisfaction after pediatric cardiac surgery. Pediatric patients are at an increased risk for inadequate postoperative pain management given age related factors. Ketorolac (KET) has been proven effective in relieving moderate to severe postoperative pain. KET is a nonsteroidal anti-inflammatory drug which is non-habit forming and used in conjunction with narcotics to improve analgesia. Narcotic medications, such as opioid patient-controlled analgesia (PCA), are effective in the management of postoperative pain; however, the side effects of prolonged opioid exposure are well documented. The purpose of this case series was to evaluate if the use of KET in the postoperative period following cardiac surgery and its effect on an opioid PCA duration.

Methods: A retrospective chart analysis was performed on all patients after cardiac surgery who were prescribed an opioid PCA from September 2018 to July 2022 at Texas Children’s Hospital. All patients were managed according to the institution’s standardized pain evaluation and pathways. Patients were identified as having an opioid PCA with concurrent KET treatment (KET+) versus an opioid PCA with no KET (KET-). A Mann Whitney U test was performed for non-parametric data comparison.

Results: A total number of 1100 patients were prescribed opioid PCAs 1174 times after cardiac surgery with the majority receiving morphine. Median age was 6.9 years (IQR 3.6,14.9); 76% were children, 14% were adults greater than 17 years of age, and 10% were less than 1 year of age. Median duration of PCA was 9 hours (IQR 6,16). KET+ cohort consisted of 690 (63%) patients, while 410 (37%) patients comprised the KET- cohort. There was no significant difference in age (p value = 0.423). The duration of PCA was significantly lower in the KET+ cohort with a median of 9 hours (IQR) in comparison to the KET- with a median duration of 12 hours (IQR) (p value = 0.001).

Discussion: While the use of an opioid PCA is an effective treatment for the management of pediatric postoperative pain, reducing the duration of opioid exposure remains a common goal. The case series indicates a significant reduction in narcotic PCA exposure with the addition of ketorolac in postoperative pain management.