KETOROLAC FOR EARLY POSTOPERATIVE ANALGESIA

Study Objective: To determine the efficacy and speed of onset of analg esia of a single dose of intravenous (IV) or intramuscular (IM) ketoro lac tromethamine following major orthopedic surgery. Study Design: Dou ble-blind, randomized, placebo-controlled trial. Setting: A district g eneral hospital in England. Patients: 112 patients aged 18 to 80 years suffering moderate or severe pain following orthopedic surgery. Inter ventions: Patients were randomized to receive 30 mg ketorolac IV, 30 m g ketorolac IM, or placebo following surgery. Measurements and Main Re sults: Verbal pain intensity scores were performed prior to admission to the study, then frequently for the first 45 minutes following admin istration of study medication, and subsequently at hourly intervals. T imes to request for further analgesia were noted. Patient assessment o f overall acceptability and pain relief of the study medication was re corded. There was no statistical difference in speed of onset of analg esia between the ketorolac groups and placebo. Median (range) times to first analgesic following study drugs were: ketorolac IV 45 minutes ( 9 to 1440 minutes), ketorolac IM 34 minutes (10 to 1440 minutes), plac ebo 24 minutes (10 to 615 minutes). There was a statistically signific ant difference between the ketorolac groups and placebo (ketorolac IV vs. placebo, p < 0.01; ketorolac IM vs. placebo, p = 0.03). Patient as sessment of overall acceptability and pain relief was significantly be tter for IV ketorolac compared with placebo (p < 0.01). By 6 hours, 78 % of the IV ketorolac group and 95% of the IM ketorolac and placebo gr oups required further analgesia. Conclusions: Despite high patient acc eptability compared with placebo, the use of ketorolac as the sole ana lgesic failed to control postoperative pain following major orthopedic surgery. IV administration of ketorolac conferred no advantages over the IM route with regard to efficacy or speed of onset.