KETOROLAC VERSUS FENTANYL FOR POSTOPERATIVE PAIN MANAGEMENT IN OUTPATIENTS

Objective: The purpose of this study was to compare the efficacy and s afety of i.v. ketorolac and fentanyl for moderate to severe postoperat ive pain in patients undergoing elective surgery in an ambulatory surg ery unit. Design: A double-blind randomized trial. Setting: An ambulat ory surgery unit in a university-affiliated hospital. Patients: Sixty- nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled. Intervention: Patients were random ly assigned to receive intravenous ketorolac 30 mg (n = 38) or fentany l 50 mu g (n = 31) for moderate to severe postoperative pain. Outcome Measures: Pain, assessed using a 100-mm visual analog scale and a 5-po int verbal pain scale; adverse effects, as well as vital signs were re corded every 15 min for 150 min or until discharge from the postanesth esia care unit, 6 and 24 h after discharge. Results: Pain reduction on both visual analog and verbal scales was significantly greater with f entanyl than ketorolac at 15 min. In addition, the proportion of patie nts requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant dif ferences between fentanyl and ketorolac between 30 and 150 min after s urgery, Notably, pain reduction was significantly greater with ketorol ac on the verbal scale at the 6 h measurement. Conclusions: Ketorolac appears not to be as effective as fentanyl in treating early postopera tive pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was m ore effective during the later postoperative period in providing longe r lasting analgesia.