University of Utah, Department of Surgery, Division of Pediatric Surgery.
University of Utah School of Medicine.
J Pediatr Surg. 2020 Nov;55(11):2393-2396. doi: 10.1016/j.jpedsurg.2020.04.001. Epub 2020 Apr 14.
Enhanced recovery protocols include multimodal perioperative pain control and frequently include use of NSAIDs. There is conflicting evidence that ketorolac use in inflammatory bowel disease (IBD) may precipitate disease flares and postoperative complications. The outcomes of children who receive ketorolac in this setting are not well known. We sought to evaluate ketorolac utilization in children following colectomy for ulcerative colitis.
All patients undergoing colectomy for ulcerative colitis between 2007 and 2017 at a tertiary children's hospital were reviewed. We collected patient age, duration of symptoms, operative details, medication utilization, length of stay, and postoperative complications. We performed a cohort comparison of these variables across patients who did vs. did not receive postoperative ketorolac.
Sixty children were identified with median age at diagnosis of 12.6 years (IQR: 9.9-14.5). At colectomy, patients had a median PUCAI score of 60 (45-70), ESR 34 mm/h (15-50), hemoglobin 10.9 g/dL (9.3-12.9), and albumin 3.1 g/dL (2.4-3.8). Postoperatively, 45% (n = 27) received ketorolac. Patients in both cohorts had a similar length of stay, duration of opioid exposure, total morphine equivalents utilized, readmission rate, and unexpected return to the operating room. There were no documented cases of postoperative bleeding, acute kidney injury, or disease related flares among children receiving ketorolac.
Administration of ketorolac after colectomy in IBD was not associated with an increase in any postoperative complications, though the study was underpowered to detect these differences. However, ketorolac administration did not lead to a decreased utilization of opioid analgesia. Further prospective research is necessary to understand whether ketorolac in this population is safe and offers benefit.
Retrospective study.
III.
强化康复方案包括多模式围手术期疼痛控制，并且经常包括使用 NSAIDs。有矛盾的证据表明，在炎症性肠病（IBD）中使用酮咯酸可能会引发疾病发作和术后并发症。在这种情况下接受酮咯酸治疗的儿童的结局尚不清楚。我们旨在评估在溃疡性结肠炎患儿接受结肠切除术后使用酮咯酸的情况。
回顾性分析了 2007 年至 2017 年间在一家三级儿童医院接受结肠切除术治疗溃疡性结肠炎的所有患者。我们收集了患者年龄、症状持续时间、手术细节、药物使用、住院时间和术后并发症等信息。我们对术后接受或未接受酮咯酸治疗的患者进行了这些变量的队列比较。
共确定了 60 名患儿，中位诊断年龄为 12.6 岁（IQR：9.9-14.5）。在结肠切除术中，患者的 PUCAI 评分中位数为 60（45-70），ESR 为 34mm/h（15-50），血红蛋白为 10.9g/dL（9.3-12.9），白蛋白为 3.1g/dL（2.4-3.8）。术后，45%（n=27）的患者接受了酮咯酸治疗。两组患者的住院时间、阿片类药物使用时间、总吗啡等效物用量、再入院率和意外返回手术室的情况相似。在接受酮咯酸治疗的患儿中，没有记录到术后出血、急性肾损伤或与疾病相关的发作等并发症。
在 IBD 患儿结肠切除术后使用酮咯酸并不会增加任何术后并发症，尽管本研究的效力不足以检测到这些差异。然而，酮咯酸的使用并未导致阿片类镇痛药使用量减少。需要进一步进行前瞻性研究，以了解在该人群中使用酮咯酸是否安全并带来益处。
回顾性研究
III 级
