Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Murdoch, John A. C.; Ramsey, Gillian; Day, Andrew G.; McMullen, Michael; Orr, Elizabeth; Phelan, Rachel; Jalink, Diederick

doi:10.1007/s12630-016-0611-4

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Concerning the effects of ketorolac in patients with LC, various studies have indicated that ketorolac can reduce pain, which is consistent with our results ( 39 ). Our findings revealed that the rate of nausea and vomiting was lower in the bupivacaine and ketorolac groups than in the placebo group.…”

Section: Discussionsupporting

confidence: 93%

“…Our findings revealed that the rate of nausea and vomiting was lower in the bupivacaine and ketorolac groups than in the placebo group. Sharma et al reported a 15 - 20% incidence of nausea and vomiting in the intraperitoneal bupivacaine group ( 18 ), which was lower than our study results, but Murdoch et al reported a 59% incidence of nausea in the ketorolac group, which was higher than our study results ( 39 ).…”

Section: Discussioncontrasting

confidence: 89%

“…The results of our study also showed that fentanyl consumption did not show a significant difference between the studied groups. Unlike our study, some previous studies have reported that bupivacaine and ketorolac can reduce the use of opioids in managing postoperative pain (39,40). Various factors may be involved in this discrepancy, related to the use of fentanyl after surgery, such as sample size, duration of surgery, type of injection (intravenous with topical), site of injection (sub-diaphragm against sublingual), anesthetic solution, time of injection (before or after surgery), residual carbon dioxide volume, and dosage and type of analgesic medications (19).…”

Section: Discussioncontrasting

confidence: 81%

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Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

et al. 2021

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Background: Postoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects. Objectives: The purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC. Methods: This randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant. Results: The intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001). Conclusions: Intraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 89%

Section: Discussioncontrasting

confidence: 81%

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Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

et al. 2021

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“…Therefore, Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), has been commonly added to IV-PCA solution to reduce opioid consumption and opioid related side effects. 35 Furthermore, some studies have shown that local anesthetics and cyclooxygenase (COX)-2 inhibitors can effectively reduce the movement-evoked pain by preventing central sensitization. 36 In addition, combination ketorolac with IV-PCA mixture was reported to shorten the postoperative recovery period in patients with colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efﬁcacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

Chen

Lei

et al. 2019

Preprint

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Backgroud Patient-controlled analgesia(PCA) with intravenous an opioid has been suggested as a effective method of postoperative pain relief. There are several randomized controlled trials (RCTs) of comparison of oxycodone and fentanyl for IV-PCA in surgical patients. The purpose of this study was to performed a meta-analysis to compare the effect of intravenous oxycodone and fentanyl on post-operative pain in sugical patients from collected current data. Methods The RCTs of oxycodone versus fentanyl for IV-PCA were gathered from PubMed, Embase, Cochrane library, CNKI and VIP data. After data extraction and quality assessment of the included RCTs, the RevMan 5.3 software was applied for meta-analysis of numerical rating scale (NRS) scores, accumulated IV-PCA consumption of oxycodone and fentanyl, patient satisfaction, postoperative nausea and vomiting (PONV), and other adverse events (AEs). Results Results reported from eight RCTs involving 600 patients are included in the meta-analysis. The NRS score at rest and upon movement of group oxycodone was signiﬁcantly lower than that of group fentanyl (WMD= -3.85, 95% CI -4.93~-2.76, P<0.00001; WMD= -4.31, 95% CI -5.79~-2.84, P<0.00001); however, the incidence of PONV and dizziness was signiﬁcantly higher in group oxycodone than in group fentanyl (OR = 2.41, 95% CI 1.60~3.63, P < 0.0001; OR=3.69, 95% CI 2.17~6.26, P<0.00001). Accumulated IV-PCA consumption in group oxycodone was less than in group fentanyl overall the 48 hours postoperatively (WMD= -12.11, 95% CI -18.42~-5.80, P = 0.0002). There was no significant difference in patient satisfaction between oxycodone and fentanyl (OR=0.73, 95% CI 0.11~5.04, P= 0.75). Conclusion According to the evidence, this meta-analysis suggest that oxycodone IV-PCA is superior to fentanyl in postoperative pain relief, whereas the higher incidence of PONV and dizziness was accompanied with oxycodone. Further large-scale and well-designed studies are needed to summarize and analyse the data to draw a more convincing conclusion.

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“…In many studies, its analgesic effect is stronger than that of other NSAIDs, such as tramadol and diclofenac (10)(11)(12)(13). Therefore, ketorolac has been widely used in various types of postoperative analgesia for colorectal surgery (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Ketorolac Administration After Colorectal Surgery Increases Anastomotic Leak Rate: A Meta-Analysis and Systematic Review

et al. 2022

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ObjectiveThis meta-analysis aimed to evaluate whether ketorolac administration is associated with an increased anastomotic leak rate after colorectal surgery.MethodsThe literature was searched using the Web of Science, Embase, and PubMed databases, and the search ended on May 31, 2020. The Newcastle–Ottawa Scale was used to assess methodological quality. Statistical heterogeneity was assessed using the Chi-square Q test and I2 statistics. Subgroup analysis was performed, and Egger's test was used to assess publication bias.ResultsThis meta-analysis included seven studies with 400,822 patients. Our results demonstrated that ketorolac administration after surgery increases the risk of anastomotic leak [OR = 1.41, 95% CI: 0.81–2.49, Z = 1.21, P = 0.23]. Low heterogeneity was observed across these studies (I2 = 0%, P = 0.51). The results of subgroup analysis showed that the use of ketorolac in case–control and retrospective cohort studies significantly increased the risk of anastomotic leak (P < 0.05). Furthermore, the subgroup analysis revealed that ketorolac use increased anastomotic leak rate in patients in the United States and Canada, and ketorolac plus morphine use did not increase anastomotic leak rate in Taiwanese patients (P < 0.05). No significant publication bias was observed (P = 0.126). Moreover, the analysis of risk factors related to anastomotic leak rate indicated that the total use of ketorolac did not increase the risk of anastomotic leak similar to the control group (P > 0.05).ConclusionThe meta-analysis indicates that the use of ketorolac increases the risk of anastomotic leak after colorectal surgery.Systematic Review RegistrationPROSPERO, identifier CRD42020195724.

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Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Cited by 8 publications

References 19 publications

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy

Comparison of efﬁcacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

Ketorolac Administration After Colorectal Surgery Increases Anastomotic Leak Rate: A Meta-Analysis and Systematic Review

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