THE EFFECT OF INTRAVENOUS KETOROLAC GIVEN INTRAOPERATIVELY VERSUS POSTOPERATIVELY ON OUTCOME FROM GYNECOLOGIC ABDOMINAL-SURGERY

Study Objectives: To examine the effect of timing of an intravenous (I V) dose (intraoperative vs. postoperative) of ketorolac tromethamine o n pain scores and overall outcome after total abdominal hysterectomy ( TAH) and myomectomy. Design: Prospective, randomized placebo-controlle d study. Patients: 248 ASA physical status I and II adult female patie nts scheduled for elective hysterectomy or myomectomy. Interventions: General anesthesia runs administered that consisted of thiopental sodi um for induction enflurane or isoflurane in nitrous oxide-oxygen for m aintenance, and small doses of fentanyl and midazolam. Patients were r andomized into three groups to receive toradol/placebo on a dosing sch edule of dose 1 given one-half hour prior to expected end of surgery, dose 2 given on awakening in the postanesthesia care unit, and doses 3 , 4, and 5 given at 6, 12, and 18 hours, respectively, after dose 2; G roup 1 patients received placebo (saline) for dose 1, ketorolac 60 mg IV for dose 2, and ketorolac 30 mg IV for doses 3, 4, and 5. Group 2 p atients received ketorolac 60 mg IV for dose I, placebo for dose 2, an d ketorolac 30 mg IV for doses 3, 4, and 5. Group 3 patients received placebo for all doses. All patients were given IV morphine PCA postope ratively and morphine usages, visual analog pain intensity (VAS) score s, as well as adverse events and median times to recovery milestones w ere recorded. Measurements and Main Results: VAS scores (mean) before dose 2 were significantly lower in Group 2 than Group 1, as were at-re st evaluations at 15 minutes and one hour. Group 2 patients also had d ecreased morphine requirements as compared to placebo. Both ketorolac groups (Groups 1 and 2) had significantly higher values for patient an d observer overall ratings, ease of nursing care, and tolerability as compared to placebo (Group 3). There were no significant differences a mong groups in adverse events or median times to recovery milestones. Conclusions: Although it is possible to demonstrate an improvement in early postoperative pain scores with intraoperative ketorolac and bett er overall ratings of ketorolac both intraoperatively and postoperativ ely as compared with placebo, the lack of clinically significant diffe rences in analgesic efficacy in the two active study, groups indicates the need for a careful consideration by the clinician of the risks ve rsus benefits involved in the administration of antiplatelet medicatio n in the perioperative period. (C) 1997 by Elsevier Science Inc.