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Perioperative Ketorolac Use in Children Undergoing Lower Extremity Osteotomies

Kay, Robert Michael MD*,†; Leathers, Michael BS; Directo, Michael P. BS; Myung, Karen MD, PhD*,†; Skaggs, David L. MD*,†

doi: 10.1097/BPO.0b013e31822ed33a
Lower Extremity

Background: Ketorolac has previously been shown to afford good pain relief in children undergoing surgery. Due to concerns about potential complications, particularly nonunion, delayed union, and excessive blood loss, ketorolac use has been limited in pediatric orthopaedics. The goal of this study is to examine complications associated with the perioperative use of ketorolac in children undergoing lower extremity osteotomies.

Methods: A retrospective review was conducted of 327 consecutive children undergoing osteotomy surgery who had a minimum of 6 months follow-up. Of the 327 patients, 299 patients (625 osteotomies) had received ketorolac perioperatively and 28 (57 osteotomies) had not.

Results: There was no significant difference in the rate of either osseous or soft tissue complications between the 2 groups. There were no nonunions in either of the groups. Delayed union occurred in 5 of 682 osteotomies (0.7%), including 0.6% in the ketorolac group (4/625 osteotomies), and 1.8% (1/57 osteotomies) in the nonketorolac group (P=0.893). Wound complications occurred in 16/327 patients overall (4.9%), including 13/299 (4.3%) in the ketorolac group and 3/28 (10.7%) in the nonketorolac group (P=0.301). There was no significant difference in estimated blood loss (EBL) (P=0.584) or the need for blood transfusion (P=0.777) between the 2 groups. Of the 19 occasions when blood was transfused perioperatively in the ketorolac group, 15 patients had undergone unilateral (3 patients) or bilateral (12 patients) varus derotational osteotomy as part of their surgery. Overall, 15 of 113 patients (13.3%) in the ketorolac group who underwent unilateral or bilateral varus derotational osteotomy required blood transfusion, with rates of 31.8% (7/22) in those who had undergone concomitant pelvic osteotomy(ies) and 8.7% (8/91) in those who had not.

Conclusions: The results of this study support the safety of perioperative ketorolac use in children undergoing lower extremity osteotomies.

Level of Evidence: Level III.

*Children’s Orthopaedic Center, Children’s Hospital Los Angeles

Keck-University of Southern California School of Medicine, Los Angeles, CA

This study was conducted at Children’s Hospital Los Angeles, Los Angeles, CA.

M.P.D. received financial support from the Keck-University of Southern California School of Medicine to conduct this research. No other author received funding for this research.

The authors declare no conflict of interest.

Reprints: Robert Michael Kay, MD, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027. E-mail:

© 2011 by Lippincott Williams & Wilkins