COMPARATIVE ANALGESIC EFFICACY OF PATIENT-CONTROLLED ANALGESIA WITH KETOROLAC VERSUS MORPHINE AFTER ELECTIVE INTRAABDOMINAL OPERATIONS

We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (b y visual analog scale [VAS]), patients were randomly assigned to one o f two groups. Group 1 (n = 25) received up to two intravenous (IV) bol uses of 5 mg of morphine followed by TV morphine PCA, whereas those in Group 2 (n = 26) received up to two TV boluses of 30 mg ketorolac, th en TV ketorolac PCA. Up to two rescue doses of morphine (5 mg per dose , subcutaneously) were given in either group when pain during deep inh alation exceeded 5/10 on VAS. Ten patients from Group 1 required rescu e doses of morphine compared to 22 patients from Group 2 (P < 0.0011). Two and 16 patients from Groups 1 and 2, respectively, were withdrawn because of inadequate analgesia (P < 0.01). Mean pain scores were les s in Group 1 than in Group 2 at each time, but only significantly so a t 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) afte r starting PCA. Time to acceptance of oral Liquids was equivalent in G roups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, althoug h well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.