Ketorolac safe perioperative analgesic in children undergoing hypospadias repair

The opioid crisis has raised concerns regarding the long-term sequela of routinely administrating opioids in paediatric patients. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) have limited use in hypospadias surgery because of the potential risk of postoperative bleeding with ketorolac.

Researchers hypothesized that administrating ketorolac at the time of hypospadias repair is not tied to increased bleeding or immediate adverse events.

The study summary includes the following:

• Researchers included patients undergoing hypospadias surgery (2018-2021).
• Outcomes included perioperative ketorolac administration, opioid prescriptions, and unplanned encounters (i.e., emergency department or office visits).
• There were 1044 patients, including 562 distal, 278 proximal and 204 hypospadias complication repairs.
• Ketorolac administration was done to 396 patients constituting 37.9 %.
• Patients receiving ketorolac were older, and these were prescribed opioids less often after surgery.
• No difference was recorded in unplanned encounters across repair types.

Multivariate logistic regression showed that ketorolac use is not tied to an increased likelihood of an unplanned encounter.

They discussed that though NSAID use is limited due to bleeding risks, our study showed no increase in unplanned patient encounters after ketorolac administration.

Further reading:

Deep learning of renal scans in children with antenatal hydronephrosis J Pediatr Urol. 2023 Jan 06