Psychomotor effects of ketorolac in comparison with buprenorphine and diclofenac [see comments]

Abstract

1. Ketorolac is an investigational non‐opioid analgesic. Buprenorphine, an opioid compound and diclofenac, a non‐steroidal anti‐inflammatory, are analgesics used in clinical practise. 2. The psychomotor effects of ketorolac (30 mg), buprenorphine (0.3 mg), diclofenac (50 mg) and placebo all administered i.m., were examined in 12 healthy male volunteers (age 19‐38 years), up to 8 h post‐dose. 3. Creatine phosphokinase (CPK) was measured up to 24 h post‐dose, providing an indication of local tissue damage following injection. 4. Buprenorphine caused significant psychomotor impairment in seven out of eight psychomotor tests. The effects consistently peaked 4 h post‐dose and were still apparent in many cases 8 h post‐dose. These psychomotor effects were supported by marked symptoms in all volunteers. 5. Ketorolac and diclofenac had no clinically significant effects on psychomotor tests and only minimal symptoms were reported. 6. Diclofenac caused a marked increased in CPK (mean Cmax 298 iu l‐1) compared with ketorolac (mean Cmax 70 iu l‐1) and buprenorphine (mean Cmax 68 iu l‐1). 7. These results suggest that ketorolac and diclofenac are suitable for administration following day case surgery.

Maintenance Therapy with Synthetic Opioids and Driving Aptitude

“…Buprenorphine injected in the muscle for example caused significant psychomotor impairment in seven out of eight psychomotor tests. The effect consistently peaked 4 h post-dose and was still apparent in many cases 8 h post-dose in an investigation of MacDonald et al [7]. However, in contrast to the acute intramuscular administration in this report, clients were maintained on a stable sublingual dosage for an extended time.…”

“…Although several studies have demonstrated that opioids such as morphine, buprenorphine and methadone do not cause marked psychomotor or cognitive impairment [4][5][6], other well-designed studies have shown that opioids can prolong the response time to different tasks, although accuracy is not impaired [5][6][7][8]. Buprenorphine injected in the muscle for example caused significant psychomotor impairment in seven out of eight psychomotor tests.…”

Traitements de substitution et conduite automobile

“…Ainsi, l'étude de SaarialhoKere et al (22) réalisée chez des volontaires sains après une prise unique de buprénorphine (0,4 mg) met en évi-dence des effets psychomoteurs modérés : léger ralentissement psychique, avec tendance à l'endormissement et à la confusion. Cette détérioration des résultats des tests psychomoteurs à la suite d'une prise unique de buprénorphine bas dosage, dont l'intensité parait être corrélée à la dose, est retrouvée dans d'autres travaux (23)(24)(25). Dans la littérature scientifique disponible aujourd'hui, une seule étude basée sur des tests de simulation dédiés à la conduite automobile et réalisée chez des patients traités par la buprénorphine haut dosage a pu être retrouvée (26).…”

The panorama of opioid‐related cognitive dysfunction in patients with cancer

“…20 -22 A recent study suggested that psychomotor and cognitive impairment in the opioid-naïve, healthy volunteer population was greatest in relation to meperidine, less in relation to hydromorphone, and least of all in relation to morphine. 23 Impairment of cognitive and psychomotor testing appears to be more pronounced when an opioid is administered parenterally, 24,25 as opposed to orally. 20,21 Furthermore, opioid-related impairment appears to be dose-related, 22 but in general the magnitude of impairment is markedly less than that associated with lorazepam.…”