Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain

Kenneth H. Gwirtz, Henry C. Kim, David Nagy, Jerry V. Young, Robert S. Byers, David A. Kovach, Wei Li

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Ketorolac is a parenteral nonsteroidal anti-inflammatory drug that provides analgesia through a peripheral mechanism. The purpose of this study was to evaluate whether the scheduled administration of intravenous ketorolac improves the analgesia provided by subarachnoid opioids after surgery. Methods. Patients undergoing major urologic surgery were enrolled in a randomized, placebo- controlled, double-blinded study and received one of two analgesic regimens. All patients were given subarachnoid opioid analgesia consisting of morphine (range, 0.55-0.8 mg) plus fentanyl (25 jig) at the completion of surgery just prior to awakening. In addition to subarachnoid opioids, patients received four doses of either intravenous placebo (group 1, n = 21) or ketorolac (group 2, n = 17) administered 30 min-utes before the anticipated completion of surgery and at 6, 12, and 18 hours after surgery. Patients in group 2 who were 65 years old or older received 30 mg ketorolac initially, with subsequent doses of 15 mg. Those younger than 65 years of age received 60 mg ketorolac initially, with subsequent doses of 30 mg. Pain scores were assessed by a blinded observer using a 10-cm visual analog scale (VAS) at 1, 8, and 24 hours after the operation. Intravenous morphine requirements while in the postanesthesia care unit (PACU) and during the following 24 hours, as well as the incidence of pruritus, nausea, naloxone usage, and bleeding were also recorded. Results were analyzed using the Wilcoxon rank-sum, Fischer's exact, chi-square, and Student's t tests. Results. Patients receiving intravenous ketorolac (group 2) in addition to subarachnoid opioids had significantly lower pain scores 1 hour after surgery, and required less supplemen-tary intravenous morphine within the first 24 postoperative hours (P <.05). The per-centage of patients requiring no analgesic intervention while in the PACU was signifi-cantly higher for those receiving ketorolac (P =.01). The incidence of opioid-related side effects was similar between groups, and no perioperative bleeding was observed. Conclusions. When used in conjunction with subarachnoid opioids, the scheduled administration of intravenous ketorolac during the first 24 hours after major urologic surgery significantly enhances analgesia and reduces the need for supplemental intra-venous opioids without affecting the incidence of side effects. Intravenous ketorolac is a safe and useful adjuvant to subarachnoid opioids in the management of acute post-operative pain. Reg Anesth 1995:20:395-401.

Original languageEnglish (US)
Pages (from-to)395-401
Number of pages7
JournalRegional Anesthesia
Volume20
Issue number5
StatePublished - Jan 1 1995
Externally publishedYes

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Ketorolac
Acute Pain
Postoperative Pain
Analgesia
Opioid Analgesics
Morphine
Pain
Intravenous Administration
Analgesics
Incidence
Placebos
Hemorrhage
Fentanyl
Pruritus
Naloxone
Visual Analog Scale
Nausea
Anti-Inflammatory Agents
Students

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Gwirtz, K. H., Kim, H. C., Nagy, D., Young, J. V., Byers, R. S., Kovach, D. A., & Li, W. (1995). Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain. Regional Anesthesia, 20(5), 395-401.

Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain. / Gwirtz, Kenneth H.; Kim, Henry C.; Nagy, David; Young, Jerry V.; Byers, Robert S.; Kovach, David A.; Li, Wei.

In: Regional Anesthesia, Vol. 20, No. 5, 01.01.1995, p. 395-401.

Research output: Contribution to journalArticle

Gwirtz, KH, Kim, HC, Nagy, D, Young, JV, Byers, RS, Kovach, DA & Li, W 1995, 'Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain', Regional Anesthesia, vol. 20, no. 5, pp. 395-401.
Gwirtz, Kenneth H. ; Kim, Henry C. ; Nagy, David ; Young, Jerry V. ; Byers, Robert S. ; Kovach, David A. ; Li, Wei. / Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain. In: Regional Anesthesia. 1995 ; Vol. 20, No. 5. pp. 395-401.
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title = "Intravenous ketorolac and subarachnoid opioid analgesia in the management of acute postoperative pain",
abstract = "Ketorolac is a parenteral nonsteroidal anti-inflammatory drug that provides analgesia through a peripheral mechanism. The purpose of this study was to evaluate whether the scheduled administration of intravenous ketorolac improves the analgesia provided by subarachnoid opioids after surgery. Methods. Patients undergoing major urologic surgery were enrolled in a randomized, placebo- controlled, double-blinded study and received one of two analgesic regimens. All patients were given subarachnoid opioid analgesia consisting of morphine (range, 0.55-0.8 mg) plus fentanyl (25 jig) at the completion of surgery just prior to awakening. In addition to subarachnoid opioids, patients received four doses of either intravenous placebo (group 1, n = 21) or ketorolac (group 2, n = 17) administered 30 min-utes before the anticipated completion of surgery and at 6, 12, and 18 hours after surgery. Patients in group 2 who were 65 years old or older received 30 mg ketorolac initially, with subsequent doses of 15 mg. Those younger than 65 years of age received 60 mg ketorolac initially, with subsequent doses of 30 mg. Pain scores were assessed by a blinded observer using a 10-cm visual analog scale (VAS) at 1, 8, and 24 hours after the operation. Intravenous morphine requirements while in the postanesthesia care unit (PACU) and during the following 24 hours, as well as the incidence of pruritus, nausea, naloxone usage, and bleeding were also recorded. Results were analyzed using the Wilcoxon rank-sum, Fischer's exact, chi-square, and Student's t tests. Results. Patients receiving intravenous ketorolac (group 2) in addition to subarachnoid opioids had significantly lower pain scores 1 hour after surgery, and required less supplemen-tary intravenous morphine within the first 24 postoperative hours (P <.05). The per-centage of patients requiring no analgesic intervention while in the PACU was signifi-cantly higher for those receiving ketorolac (P =.01). The incidence of opioid-related side effects was similar between groups, and no perioperative bleeding was observed. Conclusions. When used in conjunction with subarachnoid opioids, the scheduled administration of intravenous ketorolac during the first 24 hours after major urologic surgery significantly enhances analgesia and reduces the need for supplemental intra-venous opioids without affecting the incidence of side effects. Intravenous ketorolac is a safe and useful adjuvant to subarachnoid opioids in the management of acute post-operative pain. Reg Anesth 1995:20:395-401.",
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