Cost-effectiveness comparison between caudal block and intravenous ketorolac as an early post-operative analgesic in pediatric patients underwent surgery below umbilicus segment

Abstract

Post-operative pain treatment in pediatric is frequently inadequate that could lead to psychological,
physiological and behavioral changes. Therefore, adequate pediatric pain management is needed.
Some analgesics such as ketorolac and regional anesthesia techniques such as caudal block
have been applied to relieve pain. Ketorolac and caudal block have its own advantages and
disadvantages. The aim of study was to compare the cost-effectiveness of ketorolac and caudal
blok as a post-operative analgesic in pediatric. This was double blind randomized controlled
clinical trial with parallel design conducted in Dr. Sardjito General Hospital. The subjects were
children who underwent surgery below umbilicus segment. Seventy patients were randomly
divided into two groups with 35 patients in each group. Group I (Caudal block Group) was given
caudal block with bupivacaine 0.12% 1 mL/kg body weight (BW) whereas Group II (Ketorolac
Group) was given ketorolac 0.5 mg/kg BW intravenously (IV). The patient’s pain was scored at 0,
15, 30, 45 minute and 1, 2, 3 hours after the conscious patients using modified Children’s
Hospital of Eastern Ontario Pain Scale (mCHEOPS). Furthermore, the cost-effectiveness the
both interventions was also compared. The caudal block was more effective in reducing pain
than the ketorolac at minutes 0 (27/8 vs 10/25) and 15 (34/1 vs 18/17) (p<0.05). However, at
third hour the ketorolac revealed more effective than the caudal block (29/6 vs 32/3) (p<0.05).
The cost of the caudal block was higher than the ketorolac (IDR 95.860 ± 5.745 vs IDR 7.200
± 14.886) (p <0.05). However, the length of stay after the caudal block was shorter than the
ketorolac (40.43 ± 13.899 vs 48.57 ± 14.068) (p <0.05). Morphine was more needed for
rescue analgesic in the ketorolac (p < 0.05) in first hour of operation, whereas after three hour
operation paracetamol was more needed in caudal block (p < 0.05). In conclusion, the caudal
block is not more cost-effective than ketorolac in reducing post-operative pain in pediatric
patients underwent surgery below umbilicus segment.