COMPARISON OF ANALGESIC EFFECT OF LOCALLY AND SYSTEMICALLY ADMINISTERED KETOROLAC IN MASTECTOMY PATIENTS

Background: Ketorolac is a parenteral nonsteroidal antiinflammatory dr ug (NSAID), Two features have limited its clinical utility: tendency t o elicit kidney failure and inability to produce complete analgesia. B ecause most NSAIDs are weak acids (pKa 3-5) and become concentrated in acidic tissues, such as injured and inflamed tissues, we hypothesized that local administration may enhance its analgesic efficacy while lo wering the potential for systemic complications.Methods: We conducted a randomized, placebo-controlled study of 60 group I-III (American Soc iety of Anesthesiology criteria) mastectomy patients, 20 in each group . Near the end of surgery and every 6 h postoperatively, 20 ml of the study solution containing normal saline with or without 30 mg of ketor olac were administered simultaneously either via a Jackson-Pratt drain or intravenously in a double-blind fashion. The quality of pain contr ol, the amount and character of the drain fluid, incidence of nausea a nd vomiting, length of stay in the postoperative care unit, and amount of morphine used for treatment of breakthrough pain were recorded. Re sults: Intraoperative administration of ketorolac resulted in better q uality of pain control in the immediate postoperative period regardles s of route of administration. The incidence of nausea was significantl y higher in the placebo group, and drain output in the ketorolac group s did not exceed the output in the placebo group. Conclusion: Analgesi c of the locally administered ketorolac is equally effective to the ef ficacy of ketorolac administered intravenously.