KETOROLAC AS AN ADJUNCT TO PATIENT-CONTROLLED MORPHINE IN POSTOPERATIVE SPINE SURGERY PATIENTS

Background and Objectives. This randomized double-blind study was desi gned to determine whether administration of ketorolac either on schedu le or as a component of patient-controlled analgesia (PCA) to patients who have undergone spinal stabilization would decrease PCA morphine u se, decrease side effects, and/or enhance analgesia. Methods. Eighty i npatients undergoing spine stabilization by one surgeon were evaluated after excluding patients with contraindications to the use of ketorol ac or morphine. All patients received PCA morphine. The patients were divided into four groups, which were given either intravenous saline ( control group); intravenous ketorolac 15 mg every 6 hours; intravenous ketorolac 30 mg every 6 hours; or ketorolac added to the PCA morphine on a milligram per milligram basis. The outcome measures included pai n scores, 24-hour morphine use, level of sedation, and side effect pro file at six times during the first 24 postoperative hours. Results: Th e total dose of morphine (P <.0001) and the cumulative doses for each of the six time periods (P varied between .02 and .0001 for the six ti me periods) were significantly higher in the control group than in the other three groups. There were no differences in doses administered b y the other three groups. The pain scores were also significantly high er in the control group than in the other three groups, with no differ ences in pain scores among the other three. The sedation scores were h igher (i.e., patients more sedated) in the control group than in the o ther three groups at two of the six time periods (periods 1 and 6; P < .001). Conclusions. Ketorolac should be as a component of the PCA morp hine in patients undergoing spine stabilization surgery. This results in decreased morphine consumption, decreased somnolence, and enhanced analgesia in comparison with patients who do not receive ketorolac.