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Evaluation of Ketorolac in Children with Forearm Fractures
Author(s) -
Pierce Mary Clyde,
Fuchs Susan
Publication year - 1997
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1997.tb03638.x
Subject(s) - medicine , ketorolac , sedation , fentanyl , anesthesia , forearm , visual analogue scale , midazolam , surgery , analgesic
Objectives : To evaluate ketorolac for pain relief and an opioid‐sparing effect in children with forearm fractures necessitating reduction. Methods : A prospective, randomized, double‐blind study was conducted at an urban children's hospital ED. A convenience sample of children aged 3–18 years with isolated forearm fractures was studied. None received prior pain medication. A 10‐point visual analog scale (VAS) was used to assess pain at the time of study entry and prior to sedation/analgesia. The Children's Hospital of Eastern Ontario's Pain Score (CHEOPS), a 13‐point behavioral score, was used to assess pain during sedation. Patients received either IV ketorolac (K), 1 mg/kg, or saline (S) after entry into the study. After a minimum of 20 minutes, pain was reassessed and supplemental analgesia/sedation administered. A standard dose of midazolam, 0.1 mg/kg to a maximum of 6 mg, was given to all patients, and fentanyl was titrated at 1‐μg/kg increments based on patient need. Once the patient was comfortable, reduction was performed and a reduction CHEOPS score assigned. Results : For the 34 study children (17 K, 17 S), there was no difference in sex or mean age between the groups. Mean total doses of fentanyl were 2.26 μg/kg in the K group and 2.85 μg/kg in the S group (p = 0.07). The median changes in VAS score before and after receiving the study drug were —1.13 K and ‐0.18 S (p = 0.06). The median CHEOPS score was 10 for both groups. Seven of the 17 patients in the S group required the maximum fentanyl dose (4 μg/kg), compared with 2 of 17 in the K group (p = 0.06). Conclusions : Although ketorolac seems to add to patient comfort in children with forearm fractures, it does not have a significant opioid‐sparing effect. Ketorolac showed a trend toward pain relief, but statistical significance was not reached.