Abstract
IM ketorolac appears to be a safe non-opioid pain control measure that can be used with any topical and infiltrative local anesthesia regimen with or without sedation. It can potentially provide increased pain control resulting in a more pleasant experience for the patient and surgeon, and in patients undergoing more extensive rhinology procedures and anxious patients concerned about pain. Providing additional pain control with IM ketorolac in selected patients could be a significant variable allowing completion of planned office rhinology procedures in unexpectedly difficult cases. A well-designed clinical pain control study using IM ketorolac for office rhinology procedures has merit and should be performed, but until this occurs IM ketorolac is an option for the otolaryngologist that can be implemented now for those who desire an additional safe pain control measure.
Highlights
Balloon sinuplasty (BSP), known as balloon sinus dilation (BSD), has seen a significant percentage of cases that would generally be performed in the operating room transition to the office setting
While office-based otolaryngology procedures have been performed in the office setting for many years [1], the transition of balloon sinuplasty (BSP) procedures, known as balloon sinus dilation (BSD), from the operating room to the office setting has dramatically increased rhinology office-based procedures [2] creating an unofficial subcategory of rhinology referred to as “office rhinology”
Ketorolac is contraindicated in patients with aspirin exacerbated respiratory disease (AERD) [5,6] and given the higher prevalence of AERD in rhinology patients increased awareness is warranted
Summary
Balloon sinuplasty (BSP), known as balloon sinus dilation (BSD), has seen a significant percentage of cases that would generally be performed in the operating room transition to the office setting. Performing office-based procedures that previously were performed in the operating room requires proper patient selection, and the most effective pain and anxiety control measures possible within the comfort zone of the surgeon. Ketorolac is a pyrrolo-pyrrole nonsteroidal anti-inflammatory drug (NSAID) with a potent analgesic effect when administered intramuscularly for the treatment of acute pain [3].
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