We compared the effect of IV
ketoprofen and placebo as an adjuvant to epidural
sufentanil analgesia after major surgery. We used a prospective, randomized, double-blinded, placebo-controlled, parallel-group study design in 54 children aged 1-15 yr who received a standardized
anesthetic. Either IV
ketoprofen or saline was administered in addition to an epidural
sufentanil infusion, which was adjusted as required clinically. The study
drug infusions were discontinued when
pain scores were <3 on 0-10 scale for 6 h at a
sufentanil infusion rate of 0.03 microg x kg(-1) x h(-1). Children in the
ketoprofen group had a better
analgesic effect, as shown by decreased need for
sufentanil (mean [10th-90th percentiles] 8.3 [3.1-15.1] microg/kg vs 12.5 [6.2-18.9] microg/kg; P = 0.002) and earlier possibility to discontinuation of the epidural
sufentanil (11 [46%] vs 3 [13%]; P = 0.014) before the end of the 72-h study period. In the
ketoprofen group, median (range)
pain scores were lower during activity at 24 h (2 [0-5] vs 5 [0-7]; P = 0.01) and at 72 h (0 [0-3] vs 2 [0-6]; P = 0.033), and fewer children had inadequate
pain relief during activity at 24 h (0 vs 5; P = 0.037). Children who received
ketoprofen required fewer infusion rate adjustments (12 [4-20] vs 17 [6-42]; P = 0.016). In the
ketoprofen group, the incidence of desaturation (1 [4%] vs 6 [26%]; P = 0.035) and
fever (3 [12%] vs 11 [48%]; P = 0.008) was less than that in the placebo group. We conclude that
ketoprofen improved
postoperative pain in children.
IMPLICATIONS: We compared the effect of the IV nonsteroidal antiinflammatory
drug ketoprofen versus placebo as adjuvants to epidural
opioid analgesia with
sufentanil. The continuous IV nonsteroidal antiinflammatory
drug improved
pain after major surgery in children receiving an epidural
opioid. Although
ketoprofen reduced epidural
sufentanil requirements, the incidence of
opioid-related adverse effects was not changed.