INTRAOPERATIVE KETOROLAC HAS AN OPIOID-SPARING EFFECT IN WOMEN AFTER DIAGNOSTIC LAPAROSCOPY BUT NOT AFTER LAPAROSCOPIC TUBAL-LIGATION

Ketorolac tromethamine (Toradol(R)) is a parenteral, nonsteroidal anti inflammatory drug that is being extensively used to provide postoperat ive analgesia. This study evaluated whether intraoperative ketorolac w ould act synergistically with fentanyl to decrease postoperative analg esic requirements in outpatients undergoing gynecologic procedures. Th e patients studied were adult ASA physical status I or II females sche duled for diagnostic laparoscopy (DL) (n = 80) or laparoscopic tubal l igation (TL) (n = 46). Each patient received fentanyl 2 mu g/kg intrav enously (IV) before induction, followed by a standardized propofol ane sthetic and 2 mt of saline or ketorolac 60 mg IV in a randomized doubl e-blind fashion 30 min before the anticipated end of the operative pro cedure. Patients were assessed for postoperative pain via a 10-cm visu al analog scale (VAS) (0 = no pain; 10 = severe pain) before analgesic treatment in the postanesthesia care unit (PACU). Severe postoperativ e pain (VAS of 5 or more) was treated with incremental doses of fen ta nyl, 25-50 mu g IV by a blinded PACU nurse. Ibuprofen or acetaminophen with codeine was administered for pain control once the patient toler ated oral medications. This study showed that intraoperative ketorolac (60 mg IV) with fentanyl (2 mu g/kg IV) administered at the induction of anesthesia resulted in significant opioid sparing and a diminution in pain in the DL sample but not in the TL sample. The analgesic regi men was also associated with a lower incidence of nausea and vomiting and resulted in earlier discharge, which was not seen after TL. These results demonstrate that pain after TL is far greater than that after DL, which suggests that these procedures should be considered separate ly when designing analgesic regimens.