Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Urol. 2023 Jun;19(3):289.e1-289.e6. doi: 10.1016/j.jpurol.2023.01.014. Epub 2023 Jan 30.
INTRODUCTION & OBJECTIVE: The opioid crisis has raised concerns for long-term sequela of routine administration of opioids to patients, particularly in the pediatric population. Nonsteroidal anti-inflammatory drug use is limited in hypospadias surgery due to concerns for post-operative bleeding, particularly with ketorolac. We hypothesize that ketorolac administration at the time of hypospadias repair is not associated with increased bleeding or immediate adverse events.
A retrospective single institution study included all patients undergoing hypospadias surgery from 2018 to 2021. Outcomes measured include peri-operative ketorolac administration, opioid prescriptions, and unplanned encounters (i.e., emergency department or office visits). Comparative statistics using non-parametric and binary/categorical tests and a logistic regression were performed.
1044 patients were included, among whom there were 562 distal, 278 proximal and 204 hypospadias complication repairs. Ketorolac was administered to 396 (37.9%) patients and its utilization increased during the study period [Summary Figure]. Patients receiving ketorolac were older (p = 0.002) and were prescribed opioids less often after surgery (2.0% vs 5.2%, p = 0.009). There was no difference in unplanned encounters across repair types (p = 0.1). Multivariate logistic regression showed ketorolac use was not associated with an increased likelihood of an unplanned encounter.
The use of NSAIDs post-operatively has traditionally been limited due to concerns about bleeding risks, however the present study displayed no significant increases in unplanned patient encounters either in the ED or outpatient clinic after ketorolac administration. Our study has several limitations including its retrospective and single-institutional design, difficulties of pain assessment in pediatric population, and possibility of under estimation of unplanned encounters due to limited access to patients' records outside of our institution.
The use of ketorolac is not associated with an increase in unplanned encounters in children undergoing hypospadias repair. It should be considered a safe agent for perioperative analgesia to decrease opioid utilization. Further studies will evaluate long-term surgical outcomes in children receiving ketorolac after hypospadias repair.
阿片类药物危机引起了人们对常规给患者使用阿片类药物的长期后果的关注，尤其是在儿科人群中。由于担心术后出血，特别是使用酮咯酸，非甾体抗炎药在尿道下裂手术中的使用受到限制。我们假设在尿道下裂修复时使用酮咯酸不会增加出血或立即出现不良事件。
这是一项回顾性单机构研究，纳入了 2018 年至 2021 年期间接受尿道下裂手术的所有患者。测量的结果包括围手术期酮咯酸的使用、阿片类药物的处方和计划外就诊（即急诊或门诊就诊）。使用非参数和二项式/分类检验和逻辑回归进行了比较统计分析。
共纳入 1044 例患者，其中 562 例为远端尿道下裂、278 例为近端尿道下裂和 204 例为尿道下裂并发症修复。396 例（37.9%）患者使用了酮咯酸，且其使用率在研究期间有所增加[总结图]。使用酮咯酸的患者年龄较大（p=0.002），术后服用阿片类药物的频率也较低（2.0%比 5.2%，p=0.009）。三种修复类型之间的计划外就诊次数没有差异（p=0.1）。多变量逻辑回归显示，使用酮咯酸与计划外就诊的可能性增加无关。
由于担心出血风险，传统上术后使用 NSAIDs 受到限制，然而本研究显示，在使用酮咯酸后，在急诊室或门诊诊所，无论是 ED 还是门诊，患者的计划外就诊次数均无显著增加。我们的研究有几个局限性，包括回顾性和单机构设计、儿科人群疼痛评估的困难，以及由于我们机构以外的患者记录获取有限，可能会低估计划外就诊的可能性。
在接受尿道下裂修复的儿童中，使用酮咯酸不会增加计划外就诊次数。它应该被视为一种安全的围手术期镇痛药物，以减少阿片类药物的使用。进一步的研究将评估在接受尿道下裂修复后接受酮咯酸治疗的儿童的长期手术结果。
