Comparison of Oral Ketorolac, Intramuscular Morphine, and Placebo for Treatment of Pain After Orthopedic Surgery

Maslanka, Marc; Andrade, João Rodrigo; Maneatis, Thomas; Bynum, Lincoln J.; Digiorgio, E.

doi:10.1097/00007611-199404000-00017

Cited by 14 publications

(5 citation statements)

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“…(5) In the present study, relief from CP in responders was not obtained until high doses had been infused (mean 41 mg morphine). This is in contrast to opioid treatment of postoperative nociceptive pain where effective analgesia is obtained in most patients at doses around 10–20 mg (Leary et al ., 1976; Tigerstedt and Tammisto, 1980; Levine et al ., 1981; Ouellette, 1984; Pandit et al ., 1985; Yee et al ., 1986; Kalso et al ., 1991; Maslanka et al ., 1994; Mansfield et al ., 1996; Norholt et al ., 1996). These are doses that are much lower than those required in the responders in our study.…”

Section: Discussionmentioning

confidence: 99%

Morphine responsiveness in a group of well‐defined multiple sclerosis patients: A study with i.v. morphine

Kalman¹,

Österberg²,

Sörensen³

et al. 2002

European Journal of Pain

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Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP.

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Section: Discussionmentioning

confidence: 99%

Morphine responsiveness in a group of well‐defined multiple sclerosis patients: A study with i.v. morphine

Kalman¹,

Österberg²,

Sörensen³

et al. 2002

European Journal of Pain

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“…Oral ketorolac vs placebo. Eight reports [22][23][24][25][26][27][28][29] involved a total of 410 patients given ketorolac 10 mg orally and 380 given placebo. One report 22 also compared ketorolac 5 mg orally (30 patients) with placebo and another 24 compared ketorolac 20 mg orally (35 patients) with placebo.…”

Section: Ketorolacmentioning

confidence: 99%

“…Two patients who received ketorolac reported nausea and one reported severe headache. [25][26][27] One patient who received placebo withdrew with nausea. 26 Five studies provided information on the total number of patients who had reported adverse effects.…”

mentioning

confidence: 99%

“…[25][26][27] One patient who received placebo withdrew with nausea. 26 Five studies provided information on the total number of patients who had reported adverse effects. 23 24 26-28 Thirtyone percent (79 of 250) of patients who received ketorolac reported adverse effects compared with 18% (39/218) who received placebo.…”

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confidence: 99%

“…Six studies reported the frequency and type of individual adverse effects. [23][24][25][26][27][28] The adverse effects reported most often were drowsiness or somnolence, dizziness or lightheadedness, nausea or vomiting and dry mouth (Table 4), but there were no significant differences between ketorolac and placebo.…”

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confidence: 99%

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Single-dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis

Smith¹,

Carroll²,

Edwards³

et al. 2000

British Journal of Anaesthesia

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For a systematic review of postoperative analgesic efficacy and adverse effects of single doses, injected or oral, of pethidine and ketorolac compared with placebo, we sought published randomized studies in moderate to severe postoperative pain. Information on summed pain intensity or pain relief outcomes over 4-6 h was extracted and converted to dichotomous information to produce the number of patients with at least 50% pain relief. This was used to calculate the relative benefit and number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief. Minor and major adverse effect data were extracted and summarized. For pethidine 100 mg i.m., eight randomized, controlled studies met the inclusion criteria, with 203 patients given pethidine and 161 placebo. The NNT to produce at least 50% pain relief was 2.9 (95% confidence interval 2.3-3.9). At this dose, pethidine produced significantly more drowsiness and dizziness than placebo, with numbers-needed-to-harm (NNH) of 2.9 (2.2-4.4) and 7.2 (4.8-14), respectively. For ketorolac, 14 reports met the inclusion criteria (six i.m. and eight oral). Most i.m. information (176 patients) was available for the 30 mg dose, which had an NNT of 3.4 (2.5-4.9). Most oral information was available for the 10 mg dose, which had an NNT of 2.6 (2.3-3.1). Oral ketorolac 10 mg was consistently at least as effective as ketorolac 30 mg i.m. Only with oral ketorolac 10 mg were there significantly more adverse effects than with placebo, with an NNH for any adverse effect of 7.3 (4.7-17).

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Evidence‐based safety profile of oral ketorolac in adults: Systematic review and meta‐analysis

Esparza‐Villalpando,

Ortiz‐Barroso,

Masuoka‐Ito

2024

Pharmacology Res & Perspec

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The primary objective of the present review was to report the safety profile of oral ketorolac in adults using the systematic review and meta‐analysis methodology based on clinical trials. The present study is a PRISMA‐based systematic review and risk ratio (RR) meta‐analysis of the adverse events reported in clinical trials that used oral ketorolac; the review includes 50 clinical trials. The RR for the comparison of a single intake of oral ketorolac versus placebo, including all types of adverse events, was RR = 2.59, IC95% (1.5102; 4.4360) with p = 0.02, the RR for the comparison of a multiple intakes of oral ketorolac versus placebo for all types of adverse events was RR = 1.39, IC95% (0.95; 2.05) with p = 0.093, the RR for the comparison of a single intake of oral ketorolac versus active drugs for all types of adverse events was RR = 0.61, IC95% (0.49; 0.77) with p < 0.0001, the RR for the comparison of multiple intakes of oral ketorolac versus active drugs for all types of adverse events was RR = 0.78, IC95%(0.65; 0.93) with p = 0.006. Multiple intakes of 5, 10, or 20 mg of oral ketorolac, in treatment over 1–10 days, do not increase the risk of adverse events compared to placebo and show a tendency to reduce the risk of adverse events compared to active drugs. When a single intake of ketorolac (5, 10, 20, or 30 mg) is compared to a placebo, the risk increases only for trivial and mild adverse events.

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Comparison of Oral Ketorolac, Intramuscular Morphine, and Placebo for Treatment of Pain After Orthopedic Surgery

Cited by 14 publications

References 0 publications

Morphine responsiveness in a group of well‐defined multiple sclerosis patients: A study with i.v. morphine

Morphine responsiveness in a group of well‐defined multiple sclerosis patients: A study with i.v. morphine

Single-dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis

Evidence‐based safety profile of oral ketorolac in adults: Systematic review and meta‐analysis

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