Pain Associated with Carotid Artery Surgery Performed under Carotid Plexus Block: Preemptive Analgesic Effect of Ketorolac

Sindjelić, Radomir; Davidović, Lazar; Vlajković, G.; Marković, Miroslav; Kuzmanovic, Ilija

doi:10.2310/6670.2006.00013

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…However, war induced political and subsequent economical crisis that lasted for at least ten years and caused a huge delay of introduction of new procedures and development of different programs like endovascular, transplantation, primary care and private health insurance development program. During that time open procedures were performed with great success in these two high volume centers covering territory of 5 Million inhabitants [5][6][7][8][9]. Consequently interventional radiology has measured development and even peripheral interventions were introduced at the late nineties, its routine use has started since the Original Scientific Paper are usually investing resources in small markets through local distributors that have a cumbersome work to register products on their own.…”

Section: Discussionmentioning

confidence: 98%

Endovascular aortic repair – initial experience in the Serbian bi-centric study

Davidović

Radak

Končar³

et al. 2011

Eur Surg

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Section: Discussionmentioning

confidence: 98%

Endovascular aortic repair – initial experience in the Serbian bi-centric study

Davidović

Radak

Končar³

et al. 2011

Eur Surg

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“…Yet, the analgesic potency of ketorolac in major cardiac and non-cardiac surgeries has been well-established. 33–36 The widespread utilization of narcotic analgesia in 96% of non-keto and 99% of keto receivers in our study hampered our efforts to evaluate the efficacy of ketorolac and narcotic analgesia combined. Lastly, the PHD is an administrative database that relies on ICD codes that make it prone to entry errors.…”

Section: Discussionmentioning

confidence: 99%

Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair

et al. 2020

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Objectives The role of non-steroidal anti-inflammatory drugs in aortic aneurysm disease has been debated. Animal studies demonstrated that intrathecal ketorolac reduces the inflammatory response associated with aortic clamping. However, no human-subject study evaluated this association. Therefore, we sought to explore the effects of ketorolac use in open abdominal aortic aneurysm repair. Methods The Premier Healthcare Database (June 2009–March 2015) was inquired to capture patients who underwent open abdominal aortic aneurysm repair for non-ruptured abdominal aortic aneurysm, identified via International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Intravenous ketorolac was coded as any or none. Outcomes were in-hospital mortality, cardiac, respiratory, renal, neurological, and hemorrhagic complications. Multivariable logistic regression coarsened exact matching followed by conditional fixed-effect regression modeling were performed. Results A total of 6394 patients were identified (ketorolac: 806; 12.6%). Patients who received ketorolac were younger and less likely to have hypertension (76.1% vs. 79.3%), diabetes mellitus (12.5% vs. 17.4%), or chronic kidney disease (8.3% vs. 21.4%; all p values ≤ .033). There was no significant difference in medication use including oral non-steroidal anti-inflammatory drugs and malignant or musculoskeletal diseases. Mortality, respiratory, and renal complications were less prevalent with ketorolac (2.5% vs. 4.9%, 25.2% vs. 34.6%, 10.0% vs. 21.1%; p ≤ .002). Ketorolac was associated with lower adjusted odds for those events: 0.58 (0.36–0.93), 0.53 (0.42–0.68), and 0.72 (0.60–0.86), respectively (all p values ≤ .025). There was no association with neurological, cardiac, or hemorrhagic complications. The findings were replicated by coarsened exact matching analysis. Conclusion This study demonstrated 40% mortality reduction with intravenous ketorolac following open abdominal aortic aneurysm repair. The survival benefit could be due to its anti-inflammatory and opioid-sparing properties. This is evident by its protective effect against respiratory outcomes. The lack of association with the classical non-steroidal anti-inflammatory drugs-related cardiac and hemorrhagic complication could be attributable to the short-term use of ketorolac compared with non-steroidal anti-inflammatory drugs chronic use.

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“…In case that neurological changes occur, clamping is stopped until patient recovery. Then new clamping follows, a common carotid artery is opened longitudinally, a shunt is placed and conventional CEA is performed [22,23]. Thanks to previous strategy, we improved early results [17] and significantly reduced the usage of carotid shunt from 37% at the period between 2000 and 2003, to only 7% during last year.…”

Section: Reviewmentioning

confidence: 96%

Carotid Endarterectomy: Eversion Technique

Davidović¹,

Tomić²,

Marković³

et al. 2015

UCMS

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Abstract:The aim of this article is to explain technique of eversion CEA (carotid endarterectomy), as well as to determine that eversion CEA is more effective than conventional CEA. Eversion CEA can be performed in two methods. When atherosclerotic process mostly involves common carotid artery, the procedure should start with common carotid transection, followed by eversion CEA in cranial and than in caudal direction. The final step is reanastomosis. If atherosclerotic process is mostly localized at the internal carotid artery origin, procedure begins with origin transection. The following steps are eversion endarterectomy of the internal carotid artery, then endarterectomy of carotid bifurcation if it is necessary, and reimplantation of the internal carotid artery. There is no obvious consensus that eversion CEA is superior in regard to conventional one. However, eversion CEA is anatomic procedure that reduces ischemic and total operative time, as well as restenosis and false anastomotic aneurysms occurrence during the follow-up period. It excludes the usage of patches and enables simultaneous correction of the joined kinking or coiling. Eversion CEA, performed by an experienced surgeon is safe, effective, and durable procedure.

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Pain Associated with Carotid Artery Surgery Performed under Carotid Plexus Block: Preemptive Analgesic Effect of Ketorolac

Cited by 8 publications

References 35 publications

Endovascular aortic repair – initial experience in the Serbian bi-centric study

Endovascular aortic repair – initial experience in the Serbian bi-centric study

Intravenous ketorolac is associated with reduced mortality and morbidity after open abdominal aortic aneurysm repair

Carotid Endarterectomy: Eversion Technique

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