Optimizing pain management in pediatric palatoplasty: The role of single-dose IV ketorolac

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Created On: 05/03/2026

This study was carried out to determine the safety and opioid-sparing potency of immediate postoperative intravenous ketorolac following primary palatoplasty (cleft palate repair), with emphasis on postoperative bleeding risk, pain control, and recovery outcomes.

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Key take away

Single-dose intravenous ketorolac after primary palatoplasty improves early pain control without increasing bleeding risk.

Background

Method

This prospective cohort study with historical controls was conducted at a tertiary pediatric hospital and included 249 children who underwent primary palatoplasty. After institutional implementation of routine ketorolac use in cleft palate surgery, 124 patients received a single immediate postoperative IV dose of ketorolac (median 0.5 mg/kg) and were compared with 125 patients who did not receive ketorolac.

Safety outcomes encompassed clinically significant postoperative bleeding, supplemental oxygen requirement, and 30-day surgical complications. Effectiveness outcomes encompassed postoperative pain scores using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, total inpatient opioid consumption, time to first oral intake, antiemetic use, and length of hospital stay.

Result

Rates of postoperative bleeding, oxygen supplementation, and other adverse events were low and exhibited no pivotal differences between groups, supporting the safety of ketorolac after cleft palate repair. Children who received ketorolac had lower early postoperative pain scores, with meaningful reductions during the first postoperative hour (adjusted difference 0.54) and hours 1 to 3 (adjusted difference 0.44). The ketorolac group also demonstrated trends toward reduced opioid use, earlier oral feeding initiation, and shorter hospital stay, although these differences were not statistically significant after multivariable adjustment.

Conclusion

Immediate postoperative single-dose ketorolac after primary palatoplasty was linked with improved early postoperative pain control without increasing bleeding complications. These findings reinforce ketorolac's role in opioid-reduction strategies and multimodal analgesia protocols for pediatric cleft palate surgery, with potential benefits for better recovery and reduced opioid exposure.