Paediatrica Indonesiana

March 

VOLUME 54

NUMBER 2

Original Article

Ketorolac vs. tramadol for pain management after

abdominal surgery in children
Iman Hendarman1, Silvia Triratna1, Muhammad T. Kamaludin2, Theodorus3

Abstract
Background Tramadol is a pure analgesic widely used for
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inflammation drug (NSAID), is widely used in adults and has up
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Objective To compare the clinical efficacies of intravenous
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Methods$GRXEOHEOLQGFRQWUROOHGWULDOZDVFRQGXFWHGLQ0RK
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their pain level using the Face, Legs, Arms, Cry and Consolability
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Results 2IWKHVXEMHFWVZKRXQGHUZHQWDEGRPLQDOVXUJHU\ZLWK
JHQHUDODQHVWKHVLDZHUHER\VDQGZHUHJLUOV
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Conclusion There is no significant difference in the efficacies
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SDLQPDQDJHPHQWDIWHUDEGRPLQDOVXUJHU\LQFKLOGUHQ[Paediatr
Indones. 2014;54:118-21.]
Keywords: intravenous, ketorolac,tramadol, FLACC

118Paediatr Indones, Vol. 54, No. 2, March 2014

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VXUJHU\ H[SHULHQFH PRGHUDWHWRVHYHUH
pain and do not receive adequate pain
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adequate analgesics may minimize and prevent
complications caused by pain, help the patient feel
comfortable, and reduce morbidity and mortality
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Tramadol has been used as a postoperative
analgesic and is well tolerated in neonates and
FKLOGUHQ However, several studies reported that
the clinical efficacy of tramadol as an analgesic was
RQO\In adults, ketorolac has been widely used
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supporting the use of ketorolac for postoperative pain
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The purpose of this study was to compare
the clinical efficacies of intravenous ketorolac and
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From the Department of Child Health, Clinical Pharmacology Unit2, and

the Biostatistics and Epidemiology Unit, Sriwijaya University Medical
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Reprint requests to: Iman Hendarman, Department of Child Health,
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Methods
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dysfunction, peptic ulcers, as well as those who
used tricyclic antidepressants, selective serotonin
reuptake inhibitors (SSRI), monoamine oxide
inhibitors (MAOI), antipsychotics, acetylsalicylic
acid, oxpentafylline, probenecid, lithium salt, heparin,
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have dropped out of the study if they experienced loss
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Subjects were randomly assigned to 2 groups

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performed after the subject regained consciousness
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Subjects in group I received 2mg/kg body weight
intravenous tramadol every 6 hours, while those in
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Data was analyzed using the SPSS program
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Table 1. Characteristics of subjects by analgesic group (n=52)

Characteristics
Gender, n
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(GOCNGU
Mean age (SD), years
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Mean body weight (SD), kg
Nutritional status, n
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Indications for abdominal surgery, n
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Mean duration of surgery, minutes (SD)
Mean interval between end of surgery and onset of pain
after regaining consciousness (SD), minutes
Mean FLACC score after regaining consciousness (SD)

Ketorolac group
(n=26)

Tramadol group
(n=26)

14
12

14
12

2.3 (1.07)
5.4 (0.3)
12.3 (2.74)

2.5 (0.92)
5.9 (0.53)
13 (2.86)

5
21

8
18

2
2
4
5
6
7
71.7 (23.15)
22.3 (6.36)

4
3
5
5
4
5
69.6 (19.33)
22.5 (7.11)

6.5 (0.51)

6.5 (0.51)

Paediatr Indones, Vol. 54, No. 2, March 2014119

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This study was approved by the Board of Ethics
of Sriwijaya University Medical School and subjects
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Results
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to another hospital (2 children), or gastrointestinal
hemorrhage before completing 4 doses of analgesic
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group are shown in Table 1.
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was not significantly different between the two groups
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Rescue analgesic was given to 5/26 children in
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Based on the need for rescue analgesics, ketorolac and
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the subjects, respectively, not a statistically significant
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At 2 hours after drug administration there were
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Mean baseline pain scores in the ketorolac and
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Discussion
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WKDWNHWRURODFHIILFDF\ZDV5 while other study

120Paediatr Indones, Vol. 54, No. 2, March 2014

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However, a study found that intravenous tramadol
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One limitation of our study was the lack of homogenity
in the types of surgery our subjects underwent, some
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more homogenous subjects, in terms of indications for
surgery, is needed to limit the variability in degree of
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A previous study showed that there was a
significant decline in pain scale score after intravenous
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the decline in FLACC score took a longer time and
there was no significant difference in the time required
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might be due to the type of surgery, tonsillectomy in
their subjects, with less tissue damage and less induced
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vomiting, or GI bleeding, as well as skin bleeding,
petechiae, bradycardia, urinary retention, seizure
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one subject in the ketorolac group experienced GI
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and vomiting were observed in 2 subjects in the
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Gastrointestinal tract complaints in our tramadol group
were more frequent than in Barsoums study which
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References
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of oral tramadol hydrochloride tablets for the treatment of
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effect of intravenous ketorolac versus tramadol in pediatric
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Paediatr Indones, Vol. 54, No. 2, March 2014121