The safety and efficacy of intravenous ketorolac in patients undergoing primary endoscopic sinus surgery: a randomized, double‐blinded clinical trial

Moeller, Carl W.; Pawlowski, Julius; Pappas, Ana Lucia; Fargo, Keith N.; Welch, Kevin C.

doi:10.1002/alr.21028

Cited by 36 publications

(39 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Church et al randomized 28 FESS patients and gave either rofecoxib or hydrocodone/acetominophen after surgery and found equivalent postoperative pain control in the 2 groups . In another randomized, controlled trial, Moeller et al compared intraoperative intravenous ketorolac with fentanyl and found them to be equivalent for pain control perioperatively, with no significant change in bleeding or complications . Our study included 101 patients who were recommended ibuprofen, and there were no bleeding complications, further supporting the evidence of a lack of increased bleeding with NSAID use postoperatively.…”

Section: Discussionsupporting

confidence: 67%

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Walgama

Genç

et al. 2019

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background:The taboo of avoiding nonsteroidal antiinflammatory drugs (NSAIDs) a er functional endoscopic sinus surgery (FESS) has been waning. The impetus to reduce opioid prescriptions in view of the opioid epidemic led the authors to change their practices to include NSAIDs a er sinus surgery. This study's aim was to analyze the differences between patients before and a er we began recommending NSAIDs a er FESS. Methods:A prospective cohort study was performed on patients undergoing FESS or other endoscopic nasal surgeries at 3 institutions, by 5 rhinologists and 1 facial plastic surgeon. Before introducing NSAIDs, all patients were given a prescription for hydrocodone-acetaminophen 5/325 mg and also recommended preferentially to use acetaminophen 325 mg. A er the addition of NSAIDs, ibuprofen 200 mg and acetaminophen 325 mg were recommended preferentially, using the narcotic as a rescue medication. Patients kept a pain diary and medication log, and gave a visual analog scale (VAS) score for overall pain. Demographics, surgical variables, and comorbidities were also analyzed. Results:One hundred sixty-six total patients were recruited and had data that could be analyzed (65 without NSAIDs, 101 with NSAIDs). Overall, mean pain VAS score was 3.12 ± 1.95 for the non-NSAID group and 2.33 ± 2.30 for the NSAID group (p value = 0.006). The day with the highest mean pain was the first postoperative day. The mean number of total opioid pills taken was 6.94 ± 6.85 without NSAIDs vs 3.77 ± 4.56 with NSAIDs (p = 0.018). Age and gender were found to be the only consistently significant patient variables to affect pain. There were no bleeding complications.Conclusion: NSAID use was introduced into the practices of 5 practicing rhinologists and 1 facial plastic surgeon. No bleeding complications were seen. Both pain and overall opioid usage were reduced significantly. C 2019 ARS-AAOA, LLC.

show abstract

Section: Discussionsupporting

confidence: 67%

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Walgama

Genç

et al. 2019

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

show abstract

“…No other systematic review or meta‐analysis was found pertaining to perioperative and postoperative analgesic use for endoscopic sinus surgeries. Thirty‐two studies met the inclusion criteria for this project: all of the included studies were randomized, controlled trials (RCTs). Using the Cochrane Bias tool, we judged 4 studies to be at high risk, 21 to be at moderate risk, 6 to be at low risk, and 1 to be at unclear risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Svider

Nguyen

Yuhan

et al. 2018

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

There is evidence supporting the use of NSAIDs and gabapentin for the control of pain after endoscopic sinus surgery. Acetaminophen, α-agonists, and local anesthetics are also viable options for postoperative analgesia. Familiarity with these data is essential to facilitate the use of opioid alternatives. Further large-scale, multi-institutional, randomized trials are needed to provide conclusive recommendations for these perioperative analgesics.

show abstract

“…Other alternatives for pain control have been proposed as well. In a randomized clinical trial by Moeller et al, no differences in postoperative epistaxis rates were found in patients who received intravenous ketorolac compared to intravenous fentanyl during FESS procedures . Kim et al proposed an alternative technique utilizing topical anesthesia; this study demonstrated significantly lower reported pain and increased patient satisfaction following FESS and septoplasty procedures when patients were given topical fentanyl‐soaked nasal packing compared to saline soaked packing …”

Section: Discussionmentioning

confidence: 99%

Factors associated with opioid use after endoscopic sinus surgery

Raikundalia

Cheng

Truong³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis Responsible prescribing of postoperative pain medications is necessary in combatting the current opioid epidemic in the United States. The goal of this study was to determine which clinical factors affect opioid usage following functional endoscopic sinus surgery (FESS). Study Design Retrospective medical records study. Methods This is a single‐institution retrospective study of subjects undergoing FESS by the senior author between September 2016 and December 2017. Opioid usage was assessed for each patient at the first postoperative visit. Univariate and multivariable analyses were performed to investigate factors associated with pain medication usage. Patients using opioids prior to surgery were excluded. Results A total of 136 patients were stratified into three groups based on number of opioid tablets taken during the first week after surgery: 31 patients (23%) took no opioids, 61 patients (45%) took one to five tablets, and 44 patients (32%) took more than five tablets. Gender, extent of surgery, revision surgery, polyp status, and cystic fibrosis did not significantly vary between the three groups. Multinomial logistic regression analysis with backward stepwise variable selection method revealed that those who had septoplasty (odds ratio [OR]: 4.84, 95% confidence interval [CI]: 1.68‐13.98; P < .01) or were of younger age (OR 0.96, 95% CI: 0.93‐0.99; P = .01) had significantly higher odds of taking >5 tablets. Conclusions The majority of patients undergoing FESS did not take more than 5 opioid tablets after surgery. Concurrent septoplasty and younger age were associated with increased opioid usage. Knowledge of such factors can help surgeons to assess opioid prescribing patterns and to counsel their patients on postoperative pain.Laryngoscope, 129:1751–1755, 2019

show abstract

The safety and efficacy of intravenous ketorolac in patients undergoing primary endoscopic sinus surgery: a randomized, double‐blinded clinical trial

Abstract: In this study, IVKT was a safe analgesic in the setting of primary ESS. There was no increased risk of hemorrhage or acute blood-loss anemia. IVKT did not appear to offer statistically significant pain control over IVF.

Cited by 36 publications

References 26 publications

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Multicenter study on the effect of nonsteroidal anti‐inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery

Perioperative analgesia for patients undergoing endoscopic sinus surgery: an evidence‐based review

Factors associated with opioid use after endoscopic sinus surgery

Contact Info

Product

Resources

About