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.