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Ketorolac Use Shortens Hospital Length of Stay After Bariatric Surgery: a Single-Center 5-Year Experience. Obes Surg 2019; 29:2360-2366. [DOI: 10.1007/s11695-018-03636-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stephens DM, Richards BG, Schleicher WF, Zins JE, Langstein HN. Is ketorolac safe to use in plastic surgery? A critical review. Aesthet Surg J 2015; 35:462-6. [PMID: 25825424 DOI: 10.1093/asj/sjv005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that provides postoperative pain control and reduces narcotic requirements. However, concerns regarding postoperative hematoma have limited its use in plastic surgery. OBJECTIVES Our goal is to critically review the risk of bleeding with ketorolac in plastic surgery patients, with a focus on aesthetic surgery. METHODS A PubMed/Medline literature search of clinical trials using the keywords "surgery" and "NSAID" yielded 2574 results. Of these results, 1036 included ketorolac and twelve involved plastic surgery patients. Six studies reported postoperative hematoma rates: three prospective randomized trials, two retrospective reviews, and one case series. These were subjected to statistical analysis to determine if an association existed between ketorolac and postoperative hematomas. RESULTS Six papers reported 981 cases. Ketorolac use resulted in similar hematoma rates when compared to control groups, 2.5% (12 of 483) versus 2.4% (12 of 498), respectively (P = .79). There were no reported hematomas associated with ketorolac in over 115 patients undergoing aesthetic facial procedures. Hematoma rates of those undergoing aesthetic breast surgery, including reduction and augmentation mammoplasties, were 4.3% (11 of 257) in the ketorolac group versus 2.2% (6 of 277) in controls (P = .59). Reduction in postoperative narcotic use and improved pain scores was also reported. CONCLUSIONS Our literature review did not find a significant association between hematoma formation and ketorolac use in a variety of plastic surgery procedures. These findings are similar to those in other surgical subspecialties.
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Affiliation(s)
- Diana M Stephens
- Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Bryson G Richards
- Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - William F Schleicher
- Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - James E Zins
- Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Howard N Langstein
- Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
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Oliveri L, Jerzewski K, Kulik A. Black Box Warning: Is Ketorolac Safe for Use After Cardiac Surgery? J Cardiothorac Vasc Anesth 2014; 28:274-9. [DOI: 10.1053/j.jvca.2013.07.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Indexed: 11/11/2022]
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Smith HO, Delic L. Postoperative Surveillance and Perioperative Prophylaxis. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Management of Perioperative Pain. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bainbridge D, Cheng DC, Martin JE, Novick R. NSAID-analgesia, pain control and morbidity in cardiothoracic surgery. Can J Anaesth 2006; 53:46-59. [PMID: 16371609 DOI: 10.1007/bf03021527] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE While narcotics remain the backbone of perioperative analgesia, the adjunctive role of other analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), is being recognized increasingly. This meta-analysis sought to determine whether adjunctive NSAIDs improve postoperative analgesia and reduce cumulative narcotic requirements. METHODS A comprehensive search was undertaken to identify all randomized trials, in cardiothoracic patients, of NSAIDs plus narcotics vs narcotics without NSAIDs. Medline, Cochrane Library, EMBASE, and abstract databases were searched up to September 2005. The primary outcome was visual analogue scale (VAS) pain score. Secondary outcomes included 24-hr cumulative morphine-equivalents, rescue medications required, mortality, myocardial infarction, atrial fibrillation, stroke, renal failure, hospital readmissions, and in-hospital costs. RESULTS Twenty randomized trials involving 1,065 patients were included. A significant reduction in 24-hr VAS pain score was found in patients receiving NSAIDs [weighted mean difference (WMD) -0.91 points, 95% confidence interval (CI) -1.48 to -0.34 points]. In addition, patients required significantly less morphine-equivalents in the first 24 hr (WMD -7.67 mg, 95% CI -8.97 to -6.38 mg). No significant difference was found with respect to mortality [odds ratio (OR) 0.19, 95% CI 0.01 to 4.22], myocardial infarction (OR 0.71, 95% CI 0.09 to 5.71), renal dysfunction (OR 0.95, 95% CI 0.37 to 2.46), or gastrointestinal bleeding (OR 0.96, 95% CI 0.13 to 7.09). CONCLUSION In patients less than 70 yr of age undergoing cardiothoracic surgery, the adjunctive use of NSAIDs with narcotic analgesia reduces 24-hr VAS pain score and narcotic requirements.
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Affiliation(s)
- Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, University Hospital, Main Building, Room C3-172, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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Roediger L, Larbuisson R, Lamy M. New approaches and old controversies to postoperative pain control following cardiac surgery. Eur J Anaesthesiol 2006; 23:539-50. [PMID: 16677435 DOI: 10.1017/s0265021506000548] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. BACKGROUND New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac surgical patients. METHODS We searched Medline for the period of 1980 to the present using the key terms analgesics, opioid, non-steroidal anti-inflammatory drugs, cardiac surgery, regional analgesia, spinal, epidural, fast-track cardiac anaesthesia, fast-track cardiac surgery, myocardial ischaemia, myocardial infarction, postoperative care, accelerated care programmes, postoperative complications, and we examined and discussed the articles that were identified to be included in this review. RESULTS Pain management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast-track management of conventional cardiac surgery patients. Advances have been made in this area and encompass specific techniques, such as central neuraxial blockade or selective nerve blocks, and drugs (opioids, sedative-hypnotics and non-steroidal anti-inflammatory drugs). Ideally, these therapies provide not only patient comfort but also mitigate untoward cardiovascular responses, pulmonary responses, and other inflammatory and secondary sympathetic responses. The introduction of these newer approaches to perioperative care has reduced morbidity, but not mortality, in cardiac surgical patients. CONCLUSIONS Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of cardiac surgery, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Reorganization of the perioperative team (anaesthesiologists, surgeons, nurses and physical therapists) will be essential to achieve successful fast-track cardiac surgical programmes. Developments and improvements of multimodal interventions within the context of 'fast-track' cardiac surgery programmes represents the major challenge for the medical professionals working to achieve a 'pain and risk free' perioperative course.
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Affiliation(s)
- L Roediger
- University Hospital of Liége, Department of Anaesthesia and Intensive Care Medicine, Belgium.
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Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: A systematic review. THE JOURNAL OF PAIN 2002; 3:159-80. [PMID: 14622770 DOI: 10.1054/jpai.2002.123652] [Citation(s) in RCA: 318] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michelle Wheeler
- College of Pharmacy, Drug Information Service, University of Utah, Salt Lake City, 84112, USA
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Abstract
Without proper management, postoperative pain can grow to intolerable levels and interfere with functioning and healing. Historically, morphine had no equal for postoperative pain management. Its side effects, however, are troubling. Recently, researchers have developed many analgesics that do not induce the same side effects as morphine. Ketorolac is one example. Nevertheless, a single drug with an efficacy comparable with morphine remains elusive. In this article, the physiology of pain is reviewed and ketorolac is compared with morphine. Perianesthesia nurses are given pertinent information to enhance their ability to provide the best pain relief available for the patients in their care.
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Affiliation(s)
- Daniel Anthony
- Georgetown University School of Nursing & Health Studies, Washington, DC, USA
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Summer GJ, Puntillo KA. Management of Surgical and Procedural Pain in a Critical Care Setting. Crit Care Nurs Clin North Am 2001. [DOI: 10.1016/s0899-5885(18)30052-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rainer TH, Jacobs P, Ng YC, Cheung NK, Tam M, Lam PK, Wong R, Cocks RA. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial. BMJ (CLINICAL RESEARCH ED.) 2000; 321:1247-51. [PMID: 11082083 PMCID: PMC27526 DOI: 10.1136/bmj.321.7271.1247] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the cost effectiveness of intravenous ketorolac compared with intravenous morphine in relieving pain after blunt limb injury in an accident and emergency department. DESIGN Double blind, randomised, controlled study and cost consequences analysis. SETTING Emergency department of a university hospital in the New Territories of Hong Kong. PARTICIPANTS 148 adult patients with painful isolated limb injuries (limb injuries without other injuries). MAIN OUTCOME MEASURES Primary outcome measure was a cost consequences analysis comparing the use of ketorolac with morphine; secondary outcome measures were pain relief at rest and with limb movement, adverse events, patients' satisfaction, and time spent in the emergency department. RESULTS No difference was found in the median time taken to achieve pain relief at rest between the group receiving ketorolac and the group receiving morphine, but with movement the median reduction in pain score in the ketorolac group was 1.09 per hour (95% confidence interval 1.05 to 2.02) compared with 0.87 (0.84 to 1.06) in the morphine group (P=0.003). The odds of experiencing adverse events was 144.2 (41.5 to 501.6) times more likely with morphine than with ketorolac. The median time from the initial delivery of analgesia to the participant leaving the department was 20 (4.0 to 39.0) minutes shorter in the ketorolac group than in the morphine group (P=0.02). The mean cost per person was $HK44 ( pound4; $5.6) in the ketorolac group and $HK229 in the morphine group (P<0.0001). The median score for patients' satisfaction was 6.0 for ketorolac and 5.0 for morphine (P<0.0001). CONCLUSION Intravenous ketorolac is a more cost effective analgesic than intravenous morphine in the management of isolated limb injury in an emergency department in Hong Kong, and its use may be considered as the dominant strategy.
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Affiliation(s)
- T H Rainer
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Rooms G05/06, Cancer Center, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Lichtor JL, Sevarino FB, Joshi GP, Busch MA, Nordbrock E, Ginsberg B. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg 1999; 89:732-8. [PMID: 10475315 DOI: 10.1097/00000539-199909000-00038] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Pharmacokinetic studies have shown that oral transmucosal absorption of fentanyl is relatively rapid compared with gastrointestinal absorption, and it results in increased bioavailability. We designed this study to establish the relative potency of oral transmucosal fentanyl citrate (OTFC) compared with i.v. morphine in 133 postoperative patients. The morning after surgery, patients randomly received one dose of either OTFC (200 or 800 microg) and a placebo i.v. injection or i.v. morphine (2 or 10 mg) and an oral transmucosal placebo unit. Pain intensity, pain relief, time to meaningful pain relief, and time to remedication were recorded. Median time to onset of relief was approximately 5 min for all groups. Over the first hour, little difference among treatment groups was seen for pain intensity and pain relief. By 2 h after study drug administration, 800 microg of OTFC and 10 mg of i.v. morphine generally produced similar analgesia, which was better than the smaller doses. Duration of analgesia with the larger doses (800 microg of OTFC and 10 mg of morphine) was similar and longer that produced by the smaller doses. The larger doses of OTFC and morphine produced better and more sustained analgesia than 200 microg of OTFC or 2 mg of morphine. IMPLICATIONS The relative potency of oral transmucosal fentanyl citrate (OTFC) to i.v. morphine was 8-14:1. In this postoperative setting, OTFC produced rapid pain relief similar to that produced by i.v. morphine. The larger doses of OTFC (800 microg) and morphine (10 mg) produced better and more sustained analgesia than 200 microg of OTFC or 2 mg of morphine.
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Affiliation(s)
- J L Lichtor
- Department of Anesthesiology, The University of Chicago, Illinois, USA
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The Relative Potency of Oral Transmucosal Fentanyl Citrate Compared with Intravenous Morphine in the Treatment of Moderate to Severe Postoperative Pain. Anesth Analg 1999. [DOI: 10.1213/00000539-199909000-00038] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Neighbor ML, Puntillo KA. Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain. Acad Emerg Med 1998; 5:118-22. [PMID: 9492131 DOI: 10.1111/j.1553-2712.1998.tb02595.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether i.m. ketorolac is superior to oral ibuprofen in patients presenting to an ED in moderate to severe pain. METHODS This prospective, randomized, double-blind study involved a convenience sample of 119 patients aged > or = 18 years who presented to an urban teaching hospital ED with a self-assessed pain intensity score of 5, 6, 7, or 8 (on a numerical rating scale of 0-10). Patients were randomized to receive either 60 mg of i.m. ketorolac and a placebo capsule or 800 mg of oral ibuprofen and a saline injection. Pain scores were measured at 0, 15, 30, 45, 60, 90, and 120 minutes after dosing. Supplemental analgesics were allowed in accordance with standard medical practice. RESULTS There were 18 patients excluded who did not remain in the ED for the full 2-hour study period. Of those completing the trial, 53 patients received ketorolac and 48 patients received ibuprofen. There were no significant differences in pain scores between ketorolac and ibuprofen at any time during the study. However, there was a statistically significant decrease in pain over time in both treatment groups. Yet, 40% of the patients continued to report pain intensity scores of 5-8 at 2 hours after treatment. CONCLUSIONS I.m. ketorolac and oral ibuprofen provide comparable levels of analgesia in ED patients presenting with moderate to severe pain. Unfortunately, 40% of all the patients had inadequate pain relief (pain score > or = 5) from either ketorolac or ibuprofen.
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Affiliation(s)
- M L Neighbor
- Department of Emergency Services, San Francisco General Hospital, CA 94110, USA.
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Gillis JC, Brogden RN. Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetic properties and therapeutic use in pain management. Drugs 1997; 53:139-88. [PMID: 9010653 DOI: 10.2165/00003495-199753010-00012] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with strong analgesic activity. The analgesic efficacy of ketorolac has been extensively evaluated in the postoperative setting, in both hospital inpatients and outpatients, and in patients with various other acute pain states. After major abdominal, orthopaedic or gynaecological surgery or ambulatory laparoscopic or gynaecological procedures, ketorolac provides relief from mild to severe pain in the majority of patients and has similar analgesic efficacy to that of standard dosages of morphine and pethidine (meperidine) as well as less frequently used opioids and other NSAIDs. The analgesic effect of ketorolac may be slightly delayed but often persists for longer than that of opioids. Combined therapy with ketorolac and an opioid results in a 25 to 50% reduction in opioid requirements, and in some patients this is accompanied by a concomitant decrease in opioid-induced adverse events, more rapid return to normal gastrointestinal function and shorter stay in hospital. In children undergoing myringotomy, hernia repair, tonsillectomy, or other surgery associated with mild to moderate pain, ketorolac provides comparable analgesia to morphine, pethidine or paracetamol (acetaminophen). In the emergency department, ketorolac attenuates moderate to severe pain in patients with renal colic, migraine headache, musculoskeletal pain or sickle cell crisis and is usually as effective as frequently used opioids, such as morphine and pethidine, and other NSAIDs and analgesics. Subcutaneous administration of ketorolac reduces pain in patients with cancer and seems particularly beneficial in pain resulting from bone metastases. The acquisition cost of ketorolac is greater than that of morphine or pethidine; however, in a small number of studies, the higher cost of ketorolac was offset when treatment with ketorolac resulted in a reduced hospital stay compared with alternative opioid therapy. The tolerability profile of ketorolac parallels that of other NSAIDs; most clinically important adverse events affect the gastrointestinal tract and/or renal or haematological function. The incidence of serious or fatal adverse events reported with ketorolac has decreased since revision of dosage guidelines. Results from a large retrospective postmarketing surveillance study in more than 20,000 patients demonstrated that the overall risk of gastrointestinal or operative site bleeding related to parenteral ketorolac therapy was only slightly higher than with opioids. However, the risk increased markedly when high dosages were used for more than 5 days, especially in the elderly. Acute renal failure may occur after treatment with ketorolac but is usually reversible on drug discontinuation. In common with other NSAIDs, ketorolac has also been implicated in allergic or hypersensitivity reactions. In summary, ketorolac is a strong analgesic with a tolerability profile which resembles that of other NSAIDs. When used in accordance with current dosage guidelines, this drug provides a useful alternative, or adjuvant, to opioids in patients with moderate to severe pain.
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Affiliation(s)
- J C Gillis
- Adis International Limited, Auckland, New Zealand.
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Flores-Murrieta FJ, Granados-Soto V. Pharmacologic Properties of Ketorolac Tromethamine: A Potent Analgesic Drug. CNS DRUG REVIEWS 1996. [DOI: 10.1111/j.1527-3458.1996.tb00291.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The outcome of surgery in the elderly depends on the skill of the surgeon and the expertise of the anaesthetist caring for the patient. This anaesthetic proficiency depends initially on the application of the detailed knowledge of the drugs used during anaesthesia, and on the understanding of the way changes in the elderly patients' physiology with ageing affects both kinetic and dynamic facets of pharmacology. However, the very diversity of the elderly population makes their precise response to drugs unpredictable, and, therefore, clear, unequivocal guidance on practice is limited. The important changes in both physiology and pharmacokinetics with ageing are discussed before covering the specific drugs used in current anaesthetic practice in the United Kingdom. This review covers the drugs used primary for the induction and maintenance of anaesthesia, and only covers related fields where there are changes in recent practice that raise issues of importance during surgery. This review, therefore, deals mainly with the anaesthetic vapours and intravenous drugs, and with neuromuscular blocking agents. The restriction of space and the enormity of the subject demand that the areas covered in this review are solely limited to the major classes of drugs used routinely in general anaesthetic practice in the United Kingdom. The detailed pharmacokinetics and pharmacodynamics of drugs also used in the post-operative period, such as the wide variety of opiates, and of drugs mainly used in general medical practice, but occasionally used as premedicants or supplements during anaesthesia, have been monitored only in passing.
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Affiliation(s)
- C Dodds
- Anaesthetic Department, South Cleveland Hospital, Middlesbrough, Cleveland, U.K
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Blackburn A, Stevens JD, Wheatley RG, Madej TH, Hunter D. Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery. J Clin Anesth 1995; 7:103-8. [PMID: 7598916 DOI: 10.1016/0952-8180(94)00040-b] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (i.v.) infusion of ketorolac following lower abdominal surgery. DESIGN Randomized, double-blind, placebo-controlled, parallel-group study. SETTING Inpatient elective gynecologic surgical patients. PATIENTS 60 ASA physical status I or II patients aged 18 to 70 years scheduled for elective abdominal hysterectomy. INTERVENTIONS Following standardized preparation and anesthesia, continuous i.v. infusions of either ketorolac or placebo were administered for 24 hours postoperatively with a patients' standardized postoperative protocol. Supplementary analgesia was administered by an i.v. patient-controlled analgesia (PCA) system. MEASUREMENTS AND MAIN RESULTS A significantly lower proportion of the patients in the ketorolac group (6%) rated their pain at 24 hours as moderate or severe compared with patients in the placebo group (34%) (p = 0.04). Mean 24-hour morphine consumption was significantly lower in the ketorolac group (43 mg; SEM 5 mg) compared with the placebo group (55 mg SEM 5 mg) (p = 0.02). There was no significant difference in the incidence of postoperative hypoxemia between the groups with respect to mean times per hour spent with oxygen saturation (SPO2) less than 85%, more than 85% but less than 90%, or more than 90% but less than 94%, mean hourly SPO2, or the incidence and duration of severe hypoxemic episodes. Nausea and vomiting were the only significant adverse events, and they occurred in 30% of patients in both groups. CONCLUSION Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.
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Affiliation(s)
- A Blackburn
- Department of Anaesthesia, York District Hospital, UK
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