Intravenous ketoprofen as an adjunct to patient-controlled analgesia morphine in adolescents with thoracic surgery: A placebo controlled double-blinded study

Abstract

Background Surgery to correct pectus deformities entail substantial destruction of the thoracic skeleton and thus may cause significant postoperative pain. Aims To evaluate the efficacy of intravenous ketoprofen, a NSAID, as an adjunct to PCA morphine in pain treatment in children having pectus surgery. Methods Thirty-one children aged 10–15 years completed the study according to protocol. Children (n=14) in the ketoprofen-group received ketoprofen 1mg/kg i.v. at the skin closure, and at 8 and 16h after surgery, while children (n=17) in the placebo-group received normal saline, respectively. For rescue analgesia the patient had an access to PCA-morphine. The children expressed their pain by a coloured VAS. Results Mean cumulative 24h morphine dose used was less in the ketoprofen-group (mean±SD: 490±240μg/kg) than in the placebo-group (670±200μg/kg) (mean difference 180μg/kg, 95% CI for diff: 15–340μg/kg, P=0.03). The area under the pain intensity–time-curve was lower in the ketorpofen-group (49±26 score hour) than in the placebo-group (68±24 score hour) (mean difference 21 score hour, 95% CI for diff: 3–40 score hour, P=0.026). There was no difference between the two groups in adverse events, 4/14 in the ketoprofen group and 8/17 in the placebo-group developed oxygen desaturation, and one patient in the ketoprofen-group developed bleeding at 5h after surgery. Conclusions Intravenous ketoprofen in adjunct to PCA morphine provided a significant opioid sparing effect and improved analgesia in children having chest wall correction surgery.