KETOROLAC AND PATIENT-CONTROLLED ANALGESIA IN THE TREATMENT OF POSTOPERATIVE PAIN

Ketorolac tromethamine (Toradol(R) [Syntex, Palo Alto]), a new commerc ially available nonsteroidal antiinflammatory drug (NSAID), has approp riate solubility and minimal tissue irritation, making it suitable for intramuscular injection. Previously, NSAID have only been available f or oral use in the United States for the treatment of pain. Ketorolac, the most potent NSAID known, relieves pain through inhibition of arac hidonic acid synthesis at the cyclooxygenase level and has no central opioid effects. The results of previous studies using parenteral ketor olac in combination with patient administered narcotics have shown a 4 0 percent reduction in narcotic requirements. However, ketorolac is pr esently only approved for intramuscular injection and oral use in the United States. In a prospective, randomized study, we compared intramu scular ketorolac in combination with patient controlled intravenous na rcotic analgesia (morphine) (PCA-M) to PCA-M alone for the control of pain after extensive colonic resections. The combination of intramuscu lar ketorolac and PCA-M provided equal pain relief with no increased s ide effects when compared with narcotics alone. However, narcotic requ irements of the patients were decreased by an average of 45 percent. K etorolac and narcotics in combination provide effective postoperative pain relief and significantly decrease narcotic requirements. This com bination may be particularly beneficial in the subpopulation of patien ts especially prone to narcotic related complications.