USE OF KETOROLAC AFTER LOWER ABDOMINAL-SURGERY - EFFECT ON ANALGESIC REQUIREMENT AND SURGICAL OUTCOME

Backround: Ketorolac is a nonsteroidal antiinflammatory agent with opi oid-sparing properties. The effect of ketorolac on postoperative opioi d analgesic requirement and surgical outcome was evaluated in 198 wome n after abdominal hysterectomy procedures using a double-blind protoco l design. Methods: Patients were randomly assigned to receive either 6 0 mg intravenous (2 mi) ketorolac, followed by 30 mg intravenously (in saline 20 mi) over 30 min every 6 h, or 2 mi intravenous saline, foll owed by saline 20 mi intravenously over 30 min every 6 h, for up to 72 h. The postoperative opioid analgesic requirement was assessed using a patient-controlled analgesia (PCA) device to self administer either morphine or meperidine. The authors also evaluated pain, sedation (or drowsiness), fatigue, quality of sleep, and postoperative side effects at 2-8-h intervals for up to 72 h after surgery. Results: Ketorolac d ecreased the PCA opioid usage on the night of operation and during the first postoperative day. Ketorolac also improved the quality of sleep during the first night after surgery. Although ketorolac- (vs. saline -) treated patients had a significantly shorter time to passage of bow el gas (50+/-24 h vs. 61+/-25 h), there were no clinically significant differences in the times to oral intake, unassisted ambulation, or ho spital discharge. There were also no differences in the overall incide nce of side effects in the ketorolac- (vs. saline-) treated patients. However, the use of ketorolac with opioid PCA was associated with a re duced need for antiemetic therapy on the postsurgical ward. Conclusion s: The authors conclude that the opioid-sparing effects of ketorolac c ontributed few clinically significant advantages after abdominal hyste rectomy procedures.