• Maxie L Phillips, Bryan C Willis, Aaron J Broman, Humphrey V Lam, Thanh T Nguyen, and Thomas M Austin.
• Lincoln Memorial University, DeBusk College of Osteopathic Medicine, 6965 Cumberland Gap Pkwy, Cumberland Gap, TN 37724, USA.
• J Clin Anesth. 2016 Aug 1; 32: 162-8.

Study ObjectiveBilateral myringotomy and tympanostomy tube placement (BMT) is one of the most frequently performed pediatric outpatient procedures with 667,000 children receiving tympanostomy tubes annually. Because of this high volume, discovering the ideal analgesic regimen may lead to decreased overall postanesthesia care unit (PACU) costs while increasing patient and parent satisfaction. The purpose of this study is to determine if there is any benefit in supplementing intranasal (IN) fentanyl with intramuscular (IM) ketorolac with regard to immediate recovery characteristics.DesignRetrospective, cohort study.SettingUniversity-affiliated teaching hospital.PatientsOne thousand one hundred forty American Society of Anesthesiologists physical status 1 and 2 pediatric patients scheduled for BMT.InterventionsNo interventions were performed.MeasurementsA propensity matched cohort of pediatric patients who underwent BMT at Vanderbilt Children's Hospital from 2011 to 2014 was analyzed. The authors compared PACU recovery time, rescue analgesic administration, maximal PACU pain scores, and maximal PACU agitation scores between subgroups of patients given either IN fentanyl and IM ketorolac or IN fentanyl alone intraoperatively.Main ResultsAfter adjusting for patient demographics and fentanyl dose, the fentanyl/ketorolac group received rescue analgesics 4.7% (95% confidence interval [CI], 2.0%-7.5%) less often, displayed moderate to severe pain 4.7% (95% CI, 1.5%-8.0%) less often, and experienced emergence agitation 3.6% (95% CI, 1.5%-5.8%) less often than patients in the fentanyl-only group. This corresponded to a relative risk reduction of 127%, 76%, and 200%, respectively.ConclusionsBased on our retrospective analysis, adding IM ketorolac to IN fentanyl may be beneficial to pediatric patients undergoing BMT. However, these results should be confirmed with a prospective, double-blinded, randomized study.Copyright © 2016 Elsevier Inc. All rights reserved.

32 keywords...

hide…