Grants Funded

Abstract

Impact Statement: The proposed study will provide data on the beneficial effects of ketorolac on pain, oral intake, and narcotic medication use in pediatric patients undergoing palatoplasty. Our project, as described, is the first of its kind to study the use of ketorolac in this patient population. As this medication will be provided in an intravenous formulation, it can be administered to patients immediately following surgery when oral pain medication use would otherwise be limited. We believe the use of ketorolac will improve the post-operative outcomes of our palatoplasty patients and as such our results will be important to guide their pain management at our institution and help establish local and national guidelines regarding its use.

Project Summary: Enhanced Recovery After Surgery (ERAS) protocols to improve surgical outcomes have seen widespread adoption and discussion in the adult literature. Pain control after palatoplasty is critical to promote adequate nutrition; however, our current treatment strategies are limited by a relative paucity of data and reliance on methods abstracted from adult care pathways. Our institution successfully implemented an ERAS protocol in 2016 which standardized the use of oral acetaminophen and ibuprofen as first line pain therapy with significant decreases in narcotics used. Care pathways that reduce narcotic pain medication use stand to provide substantial benefit to patients undergoing palatoplasty given that narcotic medications can lead to respiratory depression, as well as over-sedation and lethargy. Our objective is to continue to expand upon our prior efforts with additional agents and administration routes. This project proposes to study the efficacy of intravenous (IV) ketorolac for the management of pain in patients who are undergoing cleft palate repair surgery. Ketorolac has seen use in adult surgical pain management but has yet to see widespread adoption in pediatric craniofacial surgery. While the benefits of using ketorolac for the management of post-operative pain in patients undergoing palatoplasty have been described, the data is limited by the use of historical controls and lack of randomization. The specific aims of this proposal are to evaluate the effects of IV ketorolac on post-surgical oral intake and pain control of patients undergoing palatoplasty. We propose a prospective randomized double-blinded placebo-controlled study in which patients will receive either IV ketorolac or IV placebo (saline) in the first 24 hours following surgery. Post-surgical outcomes will then be compared between groups to identify any significant differences. With this method, we hope to show that patients who receive IV ketorolac have increased oral intake within the first 24 hours after surgery as well as decreased time to first oral intake. We also hope to show that patients who receive IV ketorolac have decreased use of narcotic medications and pain scores recorded at 24 and 48 hours after surgery. Lastly, we hope to show that patients who receive ketorolac have a decreased rate of narcotic prescription at discharge.

Biography
Dr. Matthew R. Greives earned his medical degree from New York University School of Medicine during which he completed a year-long research fellowship in the Laboratory for Microvascular Research and Tissue Engineering. He went on to complete an Integrated Plastic Surgery residency at the University of Chicago and subsequently completed a fellowship in Craniofacial and Pediatric Plastic Surgery at the Children’s Hospital of Pittsburgh. He joined the faculty at the McGovern Medical School at the University of Texas Health Sciences Center at Houston in 2014. He was promoted to Associate Professor in 2020 and currently holds the Thomas D. Cronin Chair of the Division of Plastic Surgery. Dr. Greives has published over 50 papers in various leading scientific journals and has authored 3 book chapters on plastic surgery. He is the director of the Texas-Cleft-Craniofacial Center (TCCC), overseeing the care of over 1000 patients with cleft lip and palate including nearly 50 new patients annually. His clinical research interests include outcomes for patients with cleft lip and palate. Dr. Greives’s research team was one of the first to publish on the use of Enhanced Recovery After Surgery (ERAS) pathways in patients following cleft palate repair. These pathways aim to minimize narcotic usage and hospital length of stay while providing adequate pain control.