R. Baird1, R. Mujallid2, P. Ingelmo2, S. Emil1 1McGill University,Pediatric Surgery,Montreal, QC, Canada 2McGill University,Pediatric Anesthesia,Montreal, QC, Canada
Introduction: Appendicitis is the most common pediatric general surgery emergency procedure. The optimal analgesic strategy to minimize patient discomfort and adverse events while maximizing patient throughput has yet to be defined. Furthermore, the utility of ketorolac to minimize narcotic use has not previously been investigated.
Methods: A single-institution, retrospective review of a random sample of pediatric patients undergoing laparoscopic appendectomy for simple appendicitis (no evidence of perforation or gangrene) was performed over a two-year period. Analgesia administration was non-standardized. Demographics, analgesia use and outcomes were evaluated; pain was assessed using age appropriate Likert scores. Categorical and continuous variables were compared using the Fisher’s Exact and Student T test, respectively, with p=0.05 considered significant.
Results: One hundred and forty seven patients were included for analysis with a mean age of 11.7 years; 86 (58.5%) patients were male. The median length of stay was 0.7 days (25%-75%ile: 0.54-1.18). Median pain score at ward admission was 2/10 (25%-75%ile: 0 – 5.5), which worsened during admission (median 5/10; 25%-75%ile: 3.75- 7). Patients received a median of 2 doses of 10 mg/kg of oral/rectal acetaminophen, and a median of 0.16mg/kg of intravenous morphine during admission.
Thirty-one patients received ketorolac after surgery. Compared to patients not receiving ketorolac, there was no difference in the number of individuals receiving opioids (13 [41.9%] vs. 51 [43.9%], p=1), nor in the overall morphine dose administered to each group (0.12 v 0.11mg/kg, p=0.82). The median maximal pain score with ketorolac was similar to without ketorolac: (5 [25%-75%ile: 3-7] vs. 5 [25%-75%ile: 4-7]).
Conclusion: Pain after laparoscopic appendectomy may worsen during hospital admission without a protocolized approach to post-operative analgesia. Ketorolac does not improve pain control in this patient population, likely due to the lack of associated inflammation and peritonitis associated with simple appendicitis alone. Efforts to optimize post-operative pain control through protocolized care appear warranted.