Ketorolac Dose Ceiling Effect for Pediatric Headache in the Emergency Department.

Q2 Medicine Journal of Pediatric Pharmacology and Therapeutics Pub Date : 2024-10-01 Epub Date: 2024-10-14 DOI:10.5863/1551-6776-29.5.494
Brian Lefchak, Danielle Morgan, Mike Finch, Manu Madhok, Mike Raschka
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Abstract

Objective: This study sought to demonstrate a non-inferiority analgesic ceiling effect previously -demonstrated within adults for pediatric patients receiving a maximum ketorolac dose of 15 mg.

Methods: We conducted a retrospective cohort study of pediatric ED patients weighing at least 60 kg treated with 30 mg (pre-intervention) or 15 mg (post-intervention) intravenous (IV) ketorolac for headache. The primary outcome included patient-reported pain scores. Additional outcomes included demographic variables, adjunct medication use and adverse effects. Categorical data were evaluated using a χ2 test, and numerical data were evaluated using an ANOVA F test and Welch 2-sample t test.

Results: The pre- and post-intervention groups included 216 and 62 patients, respectively. Overall demographics were similar between the groups (72.3% female, 49.3% White/Caucasian, mean age 15.5 years, mean weight 79.2 kg, and mean baseline 10-point pain score 7.5). Twelve (5.6%) in the pre-intervention group required rescue analgesic compared with 2 patients (3.2%) in the post-intervention group (p = 0.416). In the pre-intervention group, 198 patients (91.7%) received nausea medication compared with 52 patients (83.9%) in the post-intervention group (p = 0.087). Mean 10-point pain scores following ketorolac administration decreased by 3.9 in the pre-intervention group compared with 5.1 in the post-intervention group (p = < 0.001). Common (0.9%) or rare (0.9%) side effects were infrequent and only seen in the pre-intervention group patients.

Conclusions: Truncating the maximum intravenous ketorolac dose in pediatric patients at least 60 kg in weight to 15 mg compared with 30 mg results in effective analgesia in pediatric patients with headache. Future research could explore differences in admission rates, treatment of other indications, or treatment with multiple-dose regimens.

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急诊科治疗小儿头痛的酮洛酸剂量上限效应。
研究目的本研究旨在证明,对于接受最大剂量为 15 毫克酮咯酸治疗的儿科患者而言,之前在成人中证实的镇痛上限效应不具有劣效性:我们对体重至少 60 公斤的儿科急诊患者进行了一项回顾性队列研究,这些患者因头痛接受了 30 毫克(干预前)或 15 毫克(干预后)的静脉注射酮咯酸治疗。主要结果包括患者报告的疼痛评分。其他结果包括人口统计学变量、辅助药物使用和不良反应。分类数据采用χ2检验,数字数据采用方差分析F检验和韦尔奇2样本t检验:干预前组和干预后组分别有 216 名和 62 名患者。两组的总体人口统计学特征相似(72.3% 为女性,49.3% 为白人/高加索人,平均年龄 15.5 岁,平均体重 79.2 千克,平均基线 10 点疼痛评分 7.5 分)。干预前组有 12 名患者(5.6%)需要使用镇痛抢救药,而干预后组只有 2 名患者(3.2%)需要使用镇痛抢救药(P = 0.416)。在干预前组中,198 名患者(91.7%)接受了恶心药物治疗,而在干预后组中,52 名患者(83.9%)接受了恶心药物治疗(p = 0.087)。使用酮咯酸后,干预前组患者的平均 10 分疼痛评分降低了 3.9 分,而干预后组降低了 5.1 分(p = < 0.001)。常见(0.9%)或罕见(0.9%)的副作用并不常见,仅出现在干预前组患者身上:结论:与 30 毫克相比,将体重至少 60 千克的儿科患者的最大静脉注射酮咯酸剂量截断为 15 毫克,可有效缓解儿科头痛患者的镇痛效果。未来的研究可以探讨入院率、其他适应症的治疗或多剂量方案治疗的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
期刊最新文献
Ketorolac Dose Ceiling Effect for Pediatric Headache in the Emergency Department. Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review. Pediatric Lead Chelation Managed During Critical Medication Shortages: Case Report and Literature Review. Pharmacogenomics in Pediatric Oncology Research and Treatment. Propranolol As a Treatment Option for Chylous Effusions and Chylous Ascites in Fetuses and Neonates: A Systematic Review.
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