THE EFFECT OF KETOROLAC ON RECOVERY AFTER OUTPATIENT GYNECOLOGIC LAPAROSCOPY

Opioids, although effective postoperative analgesics, are associated w ith undesirable side effects, To determine whether nonopioid medicatio n would reduce the amount required for postoperative analgesia, the ef ficacy of:ketorolac, an injectable nonsteroidal anti-inflammatory drug , was studied in ambulatory: patients undergoing gynecologic laparosco py. Patients were randomized to a treatment group (n = 49) or control group (n = 50), then studied using a prospective double-masked design Intraoperatively, the ketorolac treatment group received a 60-mg intra muscular injection of ketorolac; the control, group received an inject ion of placebo (0.9% sodium chloride), Anesthetic management, postoper ative pain, and the management of nausea were standardized in the two groups, Postoperative pain was treated with incremental doses of fenta nyl 25 mu g intravenously. Nausea and vomiting were treated with drope ridol of prochlorperazine, Pain and nausea assessments were done every 30 minutes in the postanesthesia care unit (PACU), at discharge, and at 24 hours after discharge, Postoperatively, for the first hour in th e PACU, visual analog scale pain scores, as well as verbal pain scores , were statistically significantly lower :in the ketorolac treatment g roup, Similarly, the severity of pain was twofold less in the ketorola c treatment group than in the control group. Less fentanyl was require d in the ketorolac group (26 +/- 20 mu g, mean +/- SD) compared with t he control group (56 +/- 32 mu g, mean +/- SD), However, there were no significant differences I between the two groups with respect to post operative sedation or nausea, although the incidence of vomiting requi ring treatment was higher in the control group, There was high overall satisfaction of patients in both groups. In conclusion, intraoperativ e administration of ketorolac resulted in fewer patients awakening in pain and in a decreased need for opioid analgesic: in the postoperativ e period, Ketorolac is an effective alternative to opioids for the con trol of postoperative pain in patients undergoing gynecologic laparosc opy.