The Effect of Ketorolac on Recovery After Anorectal Surgery: Intravenous Versus Local Administration

Coloma, Margarita; White, Paul F.; Huber, P; Tongier, William K; Dullye, Kimberlie K.; Duffy, Larry L.

doi:10.1097/00000539-200005000-00019

Cited by 44 publications

(25 citation statements)

References 11 publications

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“…NSAIDs also may exert their analgesic effects by inhibiting prostaglandin synthesis, because it is believed that the pain receptors are prostaglandin sensitive. Recently, it was reported that NSAIDs may use an alternative pathway to achieve their anti-inflammatory and analgesic effect, such as the inhibition of leukotriene production, a blockade of oxygen-free radical formation, and interference with a protein-protein interaction 18,19. In addition, NSAIDs have been shown to have a significant effect on bone metabolism 12-14.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion

Park

Moon

Park³

et al. 2005

Yonsei Med J

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Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion.

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Section: Discussionmentioning

confidence: 99%

The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion

Park

Moon

Park³

et al. 2005

Yonsei Med J

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“…Time to discharge was decreased in groups that received ketorolac (P<0.05) for ambulatory anorectal procedures. 16 With regard to timing of dosing, Sun et al 14 showed there is no difference if celecoxib is given before or after surgery.…”

Section: Nsaidsmentioning

confidence: 99%

“…16 The local application of NSAIDs may prevent some of the systemic side effects seen with administration of these drugs via the oral or injectable route. For patient populations able to tolerate NSAIDs, incorporating them as an oral adjunct has proven to be effective and safe.…”

Section: Nsaidsmentioning

confidence: 99%

Multimodal Systemic and Intra-articular Analgesics

Young

Buvanendran

2011

International Anesthesiology Clinics

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“…In the predischarge period, a significantly larger percentage of patients required rescue pain medications in the control group (67% vs 37% in the rofecoxib group, P Ͻ 0.05). At the 36-h follow-up assessment, rofecoxib-treated patients reported significantly reduced oral analgesic requirements (0 [0 -20] vs 9 pills, P Ͻ 0.05) and lower maximal pain scores, resulting in improved patient satisfaction with their postoperative pain management (3 [1][2][3][4] vs 2 [0 -3], P Ͻ 0.05). However, there were no differences in the times required to resume their activities of daily living.…”

mentioning

confidence: 99%

“…(Anesth Analg 2004;98:970 -5) N onsteroidal antiinflammatory drugs (NSAIDs) are often administered as part of a multimodal analgesic regimen for both treating and preventing pain after ambulatory surgery (1). For example, ketorolac has been reported to be effective in reducing postoperative pain and opioid analgesic requirements, as well as in facilitating an earlier discharge after anorectal surgery (2). However, concern regarding the use of nonselective NSAIDs such as ketorolac during the perioperative period relates to the possibility of increasing the risk of operative site and gastrointestinal mucosal bleeding (3) caused by blockade of prostaglandin synthesis at the cyclooxygenase (COX)-1 site (4).…”

mentioning

confidence: 99%