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Ketorolac tromethamine (Toradol) is a nonsteroidal antiinflammatory drug (NSAID) available in intramuscular (IM) and oral formulations for the management of acute pain. Intramuscular ketorolac is the only parenteral NSAID available for analgesic use in the US. The clinical profile is reviewed, and clinical studies most applicable to a postoperative patient are discussed in detail. The results of a clinical study performed at Emory University School of Medicine are presented. In this single-dose study, 176 patients received either 10 ntg of oral ketorolac, 5 mg or 10 mg of IM morphine, or placebo after orthopedic surgery. The analgesic efficacy of ketorolac was comparable to both doses of morphine and significantly superior to placebo. Ketorolac, when administered intramuscularly or orally, is a safe and effective analgesic agent for the short-term management of acute postoperative pain and can be used as an alternative to opioid therapy.

The case history of a patient with classical rheumatoid arthritis is presented. Proliferating granulation tissue at the elbow had entrapped and displaced the ulnar nerve. This was corrected surgically with almost complete restoration of nerve function. Neurological involvement in rheumatoid arthritis is briefly reviewed.Es presentate le historia clinic de un patiente con classic arthritis rheumatoide. Proleferante tissu de granulation a1 cubito habeva intrappate e displaciate le nervo ulnar. Isto esseva corrigite chirurgicamente con un quasi complete restauration del function del nervo. Le thema de affectiones neurologic in arthritis rheumatoide es revistate brevemente. URGICAL REHABILITATION OF DEFORMITIES in patients withs rheumatoid arthritis has attracted increasing attenti~n.'.~ More recently it has been suggested that surgery may have more extensive applications. Perhaps even contributing to the prevention of joint destruction by procedures such as synovectomy.The purpose of this report is to draw attention to another situation in which surgical treatment can offer considerable benefit to the patient with rheumatoid arthritis. Nerve entrapment resulting from rheumatoid involvement of neighboring structures is uncommon. Nevertheless, it is readily available to simple surgical correction. The patient described in this report illustrates many of the features of the presentation and management of this condition. CASE HISTQRYA 65-year-old housewife had suffered from classical4 seropositive rheumatoid arthritis for 13 years. The shoulders, hands and ankles were involved but the most severe pain and deformity were in the right elbow and in both knees. In consequence, she was unable to walk and was confined to a wheel chair. For several years she had been treated with corticosteroids. During the last 15 months the dose had been maintained at 50 mg. of. hydrocortisone daily by mouth together with small doses of estrogens and testosterone. She took tablets of buffered aspirin occasionally, but had never received treatment with phenylbutazone, gold, or antimalarials. Several forms of physical therapy had been used and she had Teceived repeated injections ot steroids into the shoulders, knees, and ankle joints.Early in September 1963, she developed intense pain in the right hand. Three weeks later she noticed pain, numbness, and tingling on the ulnar aspect of the palm and in the fourth and fifth fingers of the right hand. It was with these complaints that she was admitted to the Buffalo General Hospital in October, 1963. Her past medical history included pregnancies and the following surgical operations. Thyroidectomy for an enlarged gland at age 32, hysterectomy at age 42 and left nephrectomy for calculus disease at age 52. From the Departments 295Physical examination showed an obese woman, deformed by arthritis but otherwise in good health. There was no deformity of the hands, but slight and symmetrical wasting of the intrinsic muscles was noted. There was slight tenderness and soft tissue swelling in the region o...