Does Time of Administration of Intravenous Ketorolac Impact Pain-Related Outcomes in Dacryocystorhinostomy?

Abstract

ABSTRACT Purpose An emerging body of evidence indicates that intravenous ketorolac (IVK) reduces pain scores and the requirement for opioid analgesics in a variety of oculofacial procedures. This study was performed to assess the impact of timing of IVK administration on these benefits after external dacryocystorhinostomy (DCR). Methods Patients were randomized to receive IVK before (n = 50), during (n = 50), or after DCR (n = 50). An additional cohort of control patients did not receive the medication (n = 50). Postoperative pain was measured via a visual analog scale immediately after DCR on the first day after surgery (POD1). Additionally, the need for opioid analgesics to control pain was recorded. Statistical analyses were performed via a dedicated computerized software package. Results Immediately after surgery, mean pain scores were 5.26 for control patients, and 2.30, 2.44, and 2.36 for patients that received IVK pre-, intra-, and post-operatively, respectively (p < .001 for each condition, as compared to controls). On POD1, mean pain scores were 3.52 for control patients and 1.38, 1.32, and 1.28 for patients that received IVK pre-, intra-, and post-operatively, respectively (p < .001 for each condition, as compared to controls). 28% of control patients required postoperative opioid analgesics, as compared to 6%, 4%, and 4% among patients that received IVK pre-, intra-, and postoperatively, respectively (p < .05 for each condition, as compared to controls). Conclusions IVK significantly reduces postoperative pain and the requirement for opioid analgesics after DCR, regardless of the timing of administration. This benefit appears to extend into the first postoperative day.