Abstract
BackgroundSimilarity of pharmacokinetics of intranasal ketorolac to the intravenous form and other advantages have promoted its application. This study compared the analgesic effects of intravenous and intranasal ketorolac in patients undergoing mandibular fracture surgery.Material and MethodsIn this clinical trial study, Sixty-four patients with unilateral mandibular fracture were divided randomly into two groups. In group 1, 30 mg of intravenous (IV) ketorolac was injected every 8 hours and in group 2, intranasal (IN) ketorolac spray was used as a 100-µL puff in each nostril (31.5 mg) every 6 hours. After each patient regained consciousness, pain intensity was measured based on visual analogue scale for 48 hours. Finally, the total dose of the opioid analgesic agent (pethidine) and the time for the first request for an analgesic agent were recorded for each patient, and their means were compared in each group with proper statistical tests.ResultsMean pain intensity of patients at baseline was significantly higher than that at other intervals and then, it decreased significantly (P<0.001). Furthermore, 2, 4, 6 and 8 hours after surgery, mean pain intensity in the IN group was significantly lower than that in the IV group (P<0.05). In the IN group, dose of antinociceptive medicine was slightly higher and the time to request it was shorter than the other group, but it was not statistically significant (P >0.05).ConclusionsApplication of intranasal ketorolac spray decreased pain after mandibular fracture surgery, especially at 8-hour interval after surgery, decreasing the need for opioids. Key words:Ketorolac, intranasal, intravenous, mandibular fracture.
Highlights
Pain which is an unpleasant feeling caused by destruction of a tissue disrupts the daily life even in its lowest rate
Pharmacokinetics and half-life of intranasal spray are similar to the intravenous form
In group 1, a 30-mg dose of intravenous ketorolac every 8 hours was prescribed and in group 2, a 15.75-mg dose of intranasal ketorolac (SPRIX, Egalet US Inc, USA) was prescribed as a 100-μL puff in each nostril (31.5 mg) every 6 hours. -Evaluation of the study outcomes The primary outcome of this study was the relief of postoperative pain
Summary
Pain which is an unpleasant feeling caused by destruction of a tissue disrupts the daily life even in its lowest rate. In a study, intranasal ketorolac in the first hour after surgery in 300 candidates for hysterectomy and hip replacement reduced pain compared to the control group. Patients received less opioids [11] He et al [15] in a systematic review in 2012, reported that using intranasal ketorolac spray can significantly reduce postoperative pain of patients. No comprehensive study is available on the application of intravenous and intranasal ketorolac in patients undergoing maxillofacial fracture surgeries. This study aimed to compare the antinociceptive effects of intravenous and intranasal ketorolac in mandible fracture patients. This study compared the analgesic effects of intravenous and intranasal ketorolac in patients undergoing mandibular fracture surgery. Conclusions: Application of intranasal ketorolac spray decreased pain after mandibular fracture surgery, especially at 8-hour interval after surgery, decreasing the need for opioids
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