PREEMPTIVE VERSUS POSTSURGICAL ADMINISTRATION OF KETOROLAC FOR HYSTERECTOMY

Seventy-seven women who underwent routine vaginal or abdominal hystere ctomy were randomly allocated to receive intravenous ketorolac 30 mg e ither 30 min before surgical incision (pre-emptive group, n = 37), or at the end of the surgical procedure (post-surgical group, n = 40). Th e patients received routine post-operative care, which included morphi ne by patient-controlled analgesia, 1 mg per demand with a lockout of 6 min and a background infusion of 1 mg h(-1). In addition, pain was a ssessed at 12 and 24 h using a 100 mm visual analogue scale (VAS), bot h at rest and on coughing. At 24 h, the median VAS at rest was 24 mm ( range 0-80) in the pre-emptive group and 28 mm (range 0-100) in the po st-surgical group. The average morphine consumption rate over the firs t 24 h was 1.9 mg h(-1) (SD +/- 0.6) in the pre-emptive group, and 2.2 mg hr(-1) (SD +/- 1.1) in the post-surgical group. There were no sign ificant differences on univariate testing. Subsidiary stepwise multipl e regression modelling identified age, weight, type of hysterectomy, a nd the timing of ketorolac administration as significant explanators o f post-operative morphine consumption. A statistically significant pre -emptive analgesic effect was therefore identifiable, but the clinical significance is uncertain in relation to the other influences on post operative analgesic requirements.