Intraoperative ketorolac dose of 15 mg versus the standard 30 mg on early postoperative pain after spine surgery: A randomized, blinded, non-inferiority trial

Duttchen, Kaylene; Lo, Andy Y. H.; Walker, Andrew; McLuckie, Duncan; Guzman, Cecilia De; Roman-Smith, Helen; Davis, Melinda

doi:10.1016/j.jclinane.2017.05.013

Cited by 32 publications

(14 citation statements)

References 16 publications

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“…The 2 RCTs that tested paracetamol found that it was more effective than placebo and less effective than dexketoprofen in reducing pain scores . The RCTs that tested systemic lidocaine, ketorolac, and NSAIDs (tenoxicam) led to controversial results . Upton et al found that fentanyl administered while maintaining an Analgesia Nociception Index of > 50 with boluses of 50 μg (in patients < 50 years of age) or 25 μg (in patients > 50 years of age) was more effective than the “classic” administration …”

Section: Resultsmentioning

confidence: 99%

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Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

et al. 2018

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Clinical evidence on perioperative pain management in patients undergoing spine procedures have significantly evolved after the review published in 2012. The aim of this systematic review was to report the latest evidence published. These include the preoperative use of dexamethasone, which was shown to be able to reduce pain at mobilization but not to reduce pain at rest or total morphine consumption; the use of gabapentinoids as part of a multimodal analgesic approach; and the safety and effectiveness of the intraoperative use of ketamine, dexketoprofen, and tramadol. Finally, electrical nerve stimulation is gaining interest and is potentially suitable for clinical needs.

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Section: Resultsmentioning

confidence: 99%

“…The 29 RTCs that tested therapies administered during the intraoperative period included systemic pharmacological therapies (19 studies) and locoregional anesthetic drugs (10 studies) (see Table ).…”

Section: Resultsmentioning

confidence: 99%

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

et al. 2018

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“…Lastly, we utilized other concurrent multimodal analgesic strategies (e.g., ketorolac and dexamethasone) and they may have reduced the potential benefits of esmolol. [ 18 , 41 ] Future studies to confirm or refute these potential explanations are warranted.…”

Section: Discussionmentioning

confidence: 99%

“…At the end of the surgical procedure, all subjects received intravenous ondansetron 4 mg and 30 mg of intravenous ketorolac. [ 18 , 19 ]…”

Section: Methodsmentioning

confidence: 99%

Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy

2018

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Introduction:Intraoperative systemic esmolol has been shown to reduce postsurgical pain. Nonetheless, it is unknown whether the use of intraoperative systemic esmolol can improve patient-reported postsurgical quality of recovery. The main objective of the current investigation was to evaluate the effect of intraoperative esmolol on postsurgical quality of recovery. We hypothesized that patients receiving intraoperative esmolol would report better quality of postsurgical recovery than the ones receiving saline.Methods:The study was a prospective randomized double-blinded, placebo-controlled, clinical trial. Healthy female subjects undergoing outpatient hysteroscopic surgery under general anesthesia were randomized to receive intravenous esmolol administered at a rate of 0.5 mg/kg bolus followed by an infusion of 5 to 15 μg/kg/min or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included postoperative opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test.Results:Seventy subjects were randomized and 58 completed the study. There was not a clinically significant difference in the global QoR-40 scores between the esmolol and saline groups at 24 hours, median (interquartile range) of 179 (171–190) and 182 (173–189), respectively, P = .82. In addition, immediate post-surgical data in the post-anesthesia care unit did not show a benefit of using esmolol compared to saline in regard to pain scores, morphine consumption, and postoperative nausea and vomiting.Conclusions:Despite current evidence in the literature that intraoperative esmolol improves postsurgical pain, we did not detect a beneficial effect of intraoperative esmolol on patient-reported quality of recovery after ambulatory surgery. Our results confirm the concept that the use of patient-centered outcomes rather than commonly used outcomes (e.g., pain scores and opioid consumption) can change the practice of perioperative medicine.

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“…2,3 The current emphasis on the need to use multimodal analgesics to improve postsurgical pain and reduce opioid intake makes the study very relevant in perioperative medicine. 4,5 Although the study of Na et al was well conducted, there are some questions regarding the study that need to be clarified. First, it is not clear if any local anesthetics were used in the surgical incision as this can substantially alter the study outcomes.…”

mentioning

confidence: 99%

Postoperative Pain and Opioid Consumption in the Acute Postoperative Period after Laparoscopic Gastrectomy

Kendall

Castro-Alves

2018

Journal of Gastrointestinal Surgery

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Intraoperative ketorolac dose of 15 mg versus the standard 30 mg on early postoperative pain after spine surgery: A randomized, blinded, non-inferiority trial

Cited by 32 publications

References 16 publications

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy

Postoperative Pain and Opioid Consumption in the Acute Postoperative Period after Laparoscopic Gastrectomy

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