Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain

O′Hara, Dorene A.; Fragen, Robert J.; Kinzer, Mary; Pemberton, D.

doi:10.1038/clpt.1987.71

Cited by 232 publications

(61 citation statements)

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“…It is a non-steroidal anti-inflammatory drug (NSAID) with proven efficacy in the management of moderate to severe postoperative pain. [1][2][3] Ketorolac can be administered orally, parenterally, or topically 4 either alone or in combination with opioids. When used as an adjunct, there may be a 25-50% reduction in opioid requirements, which may reduce the incidence of adverse side effects associated with opioid consumption.…”

Section: Résumémentioning

confidence: 99%

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Cawthorn

Phelan

Davidson

et al. 2012

Can J Anesth/J Can Anesth

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Purpose We conducted a retrospective review following concerns involving a suspected increase in the requirement for surgical re-exploration for hematoma evacuation when ketorolac was administered perioperatively in patients undergoing reduction mammoplasty. Methods Following ethics approval, a retrospective chart review was conducted of all patients who underwent reduction mammoplasty at our two institutions from the time ketorolac became available in 2004 until surgeons requested its use discontinued in 2007. The data we collected included patient demographics, ketorolac administration, requirement for surgical re-exploration, documented hematoma formation not requiring surgical re-exploration, and excessive bleeding in the perioperative period. Three hundred and seventy-nine patient records were reviewed; 127 of the patients received a single intravenous dose of ketorolac (15 or 30 mg), and 252 of the patients did not receive ketorolac.Results Patients who received ketorolac were at an increased risk of requiring surgical re-exploration for hematoma evacuation (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.4 to 9.6) and hematoma formation not requiring re-exploration (RR = 2.2; 95% CI,

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Section: Résumémentioning

confidence: 99%

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Cawthorn

Phelan

Davidson

et al. 2012

Can J Anesth/J Can Anesth

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“…COX inhibitors are, however, very efficient drugs in the treatment of postoperative inflammation and pain in orthopaedic trauma and surgery. Several studies have proven their superior effects compared to other analgesics like acetaminophen, codeine, and opioids [10,11,25,44,48]. It has been demonstrated that the analgesic and antiinflammatory effects of conventional COX inhibitors are attributed to the inhibition of COX-2, which is the COX isoform involved in the induction of pain and inflammation [18,57].…”

Section: Introductionmentioning

confidence: 99%

Parecoxib and Indomethacin Delay Early Fracture Healing: A Study in Rats

Dimmen

Nordsletten

Madsen

2009

Clinical Orthopaedics &Amp; Related Research

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Nonsteroidal antiinflammatory drugs (NSAIDs) are used to reduce inflammatory response and pain. These drugs have been reported to impair bone metabolism. Parecoxib, a specific COX-2 inhibitor, exerts an inhibitory effect on the mineralization of fracture callus after a tibial fracture in rats. Decreased bone mineral density (BMD) at a fracture site may indicate impairment of early healing, casting doubt on the safety of using COX-2 inhibitors during the early treatment of diaphyseal fractures. Fortytwo female Wistar rats were randomly allocated to three groups. They were given parecoxib, indomethacin, or saline intraperitoneally for 7 days after being subjected to a closed tibial fracture stabilized with an intramedullary nail. Two and 3 weeks after surgery, the bone density at the fracture site was measured using dual energy xray absorptiometry (DEXA). Three weeks after the operation the rats were euthanized and the healing fractures were mechanically tested in three-point cantilever bending.Parecoxib decreased BMD at the fracture site for 3 weeks after fracture, indomethacin for 2 weeks. Both parecoxib and indomethacin reduced the ultimate bending moment and the bending stiffness of the healing fractures after 3 weeks. These results suggest COX inhibitors should be avoided in the early phase after fractures.

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“…6,7 Ketorolac tromethamine is a parenterally active and potent NSAID with an analgesic efficacy comparable to approximately 12 mg of morphine. 9 Its topical administration has been shown to be as effective as systemic administration in mastectomies 10 and more effective when infiltrated locally in inguinal hernia repair.…”

mentioning

confidence: 99%

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

Murdoch

Ramsey

Day

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Ketorolac is a parenterally active nonsteroidal anti-inflammatory drug with localized anti-inflammatory properties. We examine the postoperative analgesic efficacy of locally administered intraperitoneal (IP) ketorolac compared with intravenous (IV) ketorolac during laparoscopic cholecystectomy. Methods With institutional ethics approval, 120 patients undergoing elective laparoscopic cholecystectomy were randomized to receive intraoperative 1) IP ketorolac 30 mg ? intravenous saline (IP group), 2) intraperitoneal saline ? IV ketorolac 30 mg (IV group), or 3) intraperitoneal saline ? intravenous saline (Control group) under standardized anesthesia. The primary and secondary outcomes were postoperative fentanyl requirements in the postanesthesia care unit and the time to first analgesic request, respectively. Other outcomes examined included abdominal pain (at rest and with coughing), shoulder pain, nausea, vomiting, and any other postoperative complications.Results On average, patients receiving IP ketorolac required less (mean difference, 29 lg; 95% confidence interval [CI], 2 to 56; P = 0.04) fentanyl than patients in the Control group but a similar (mean difference, 16 lg; 95% CI, 12 to 43; P = 0.27) amount compared to patients in the IV group. There was an increase in the median (interquartile range

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Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain

Cited by 232 publications

References 0 publications

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Parecoxib and Indomethacin Delay Early Fracture Healing: A Study in Rats

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

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