LAUSR

To the Editor: I read with great interest the article by Adams and colleagues in a recent issue of the journal.1 The authors performed a retrospective study involving 342 pediatric patients undergoing supracondylar humerus fracture repair and concluded that the complementary administration of ketorolac reduces postoperative pain, opioid consumption, and shortens the length of hospital stay in these pediatric patients. The authors should be applauded for performing a well-designed study in an important topic (eg, recovery) in pediatric patients undergoing surgery.2,3 The need to reduce postoperative opioid consumption and health care costs makes the topic very important in perioperative medicine.4,5 Nonetheless, there are some critical points that need to be clarified by the authors to determine the validity of their findings. First, it is unclear if the authors adjusted for other potential multimodal analgesics in their analysis (eg, acetaminophen). Second, it is also unclear if the authors adjusted their results for the intraoperative use of nerve blocks as this can substantially change the study outcomes. Last, it would be important to adjust the length-of-stay analysis by the attending provider of record as no specific discharge criteria were used. It is possible that the attending that uses ketorolac also discharges their patient’s faster.6 I would welcome comments to address the aforementioned issues as they were not discussed by the authors. This would help to further substantiate the findings of this important study.