Determining the Safety of Ketorolac in Pediatric Spinal Surgery: An Integrative Review

Marisol Martinez, CRNA

DNP Nurse Anesthesia 

Determining the Safety of Ketorolac in Pediatric Spinal Surgery: An Integrative Review

Project Category: Evidence Synthesis

Project Team:  Marisol Martinez, DNP, CRNA, Leslie Loya, DNP, CRNA Michael Ledvina, DNAP, CRNA, Jennifer Greenwood, PhD, CRNA (Advisor)

Abstract

Background: The use of ketorolac as an adjunct for pain management to decrease opioid consumption in pediatric patients in the perioperative period is not a widely accepted practice. However, providers are reluctant to use this analgesic due to the presumed risk of bleeding complications. In order to determine the risk of bleeding in pediatric patients undergoing spine surgery, an integrative review of eleven articles was conducted. 

Methods: An integrated review was performed using a systematic search of PubMed, CINAHL Complete, Cochrane Library, and Google Scholar databases. A total of 11 studies (n=13,539 patients) met the inclusion criteria. The risk of bias was evaluated using the JBI critical appraisal checklist.  The primary outcomes examined included pain scores, opioid use, and the incidence of postoperative bleeding.

Results: Six of the eleven studies measured the incidence of bleeding in patients receiving intravenous ketorolac. The intraoperative use of intravenous ketorolac did not increase the incidence of perioperative bleeding in pediatric spinal surgery. Eight studies measured pain outcomes which demonstrated that patients who received ketorolac as part of their analgesic plan, consistently reported lower pain scores and lower opioid consumption.

Conclusion: The use of intravenous ketorolac as an adjunct in pain management for pediatric patients undergoing spinal surgery improved the quality of analgesia without increasing the blood loss postoperatively.  Given ketorolac benefits and the absence of evidence of it increasing the risk of bleeding in this population, providers should consider its use during the care of these patients.

Full Manuscript Slide Presentation Video