Ketorolac vs. tramadol for pain management after abdominal surgery in children

Iman Hendarman (Department of Child Health, Sriwijaya University Medical School, Palembang)
Silvia Triratna (Department of Child Health, Sriwijaya University Medical School, Palembang)
Muhammad Kamaludin (Clinical Pharmacology Unit, Sriwijaya University Medical School, Palembang)
Theodorus Theodorus (Biostatistics and Epidemiology Unit, Sriwijaya University Medical School, Palembang)

Paediatrica Indonesiana
Vol 54 No 2 (2014): March 2014

Background Tramadol is a pure analgesic widely used forpostoperative treatment and well tolerated by children. Howevet;it has only a 50% efficacy. Ketorolac, a non􀁙steroid anri􀁙inflammation drug (NSAID), is widely used in adults and has upto 85% clinical efficacy. Data supporting the use of ketorolac inchildren has been limited.Objective To compare the clinical efficacies of intravenousketorolac and tramadol for moderate􀁙to􀁙severe pain managementafter abdominal surgery in children.Methods A double􀁙blind controlled trial was conducted in Moh.Hoesin Hospital, Palembang, from January to June 2012. Subjectswere postoperative children aged 1 􀁙 7 years who met the inclusioncriteria. T hey were randomized into two groups who receivedeither intravenous ketorolac or tramadol. Subjects assessedtheir pain level using the Face, Legs, Anns, Cry and Consolability(FLACC) pain scale. T he FLACC scores ::::;3 were considered toindicate clinical success of the intervention. Data were analyzedby T􀁙test, Chi􀁙square test, and Fischer's exact test.Results Of the 60 subjects who underwent abdominal surgery withgeneral anesthesia, 31 (52%) were boys and 29 (48%) were girls.Subjects' mean age and body weight were 3.7 (SD 1.82) years and12.6 (SD 2.85) kg, respectively. Mean duration of surgery was 71.7(SD 21.11) minutes and mean post􀁙operative FLACC score was6.6 (SD 0.5). Eight subjects dropped out of the study. Efficacies ofketorolac and tramadol were not significantly different at 21/26 and17/26, respectively (P=OJ5). In addition, there was no significantdifference in the number of patients experiencing a >3 FLACCscore decline between ketorolac and tramadol groups (P=0.61).Conclusion T here is no significant difference in the efficaciesof intravenous ketorolac and tramadol for moderate􀁙to􀁙severepain management after abdominal surgery in children. [PaediatrIndones.2014;54:118.21.].