Safety and efficacy of ketorolac in children after cardiac surgery

Objective To evaluate the nephrotoxic and opioid-sparing effects of ketorolac in children after cardiac surgery. Design A retrospective cohort study. Setting A Cardiac Critical Care Unit in a university-affiliated children’s hospital. Subjects Children less than 18 years of age who underwent low-risk cardiac surgery from July 2002 to December 2005. Results Among 248 children studied, 108 received ketorolac and 140 did not. The ketorolac group was older, included a larger proportion of atrial septum defect repairs and a smaller proportion of ventricular septum defect repairs compared to the control group. The median change in serum creatinine did not differ between the ketorolac group and the control group (% change [IQR]); 12% [ 1 – 25 ] increase versus 12% [−3 to 31] increase, P = 0.86. On postoperative day 0 or 1, the ketorolac group received less opioids than control group. There was no difference in duration of mechanical ventilation or in length of stay between groups. Conclusion Ketorolac started in the first 12 h after a low-risk cardiac surgery in children is not associated with a measurable difference in renal function. The data suggest that ketorolac may be effective in reducing the exposure to opioids. Further studies are required to define subsets of children after cardiac surgery who could safely benefit from ketorolac therapy to reduce pain.