EFFECT OF INTRAOPERATIVE IV KETOROLAC ON POSTOPERATIVE PAIN AND VOMITING AFTER GYNECOLOGIC LAPARASCOPY

Abstract

S26 INTRODUCTION: Opioids, although effective postoperative analgesics are associated with undesirable side effects. To determine whether nonopioid medication could replace or reduce the amount of narcotic for postoperative analgesia, the effect of the NSAID Ketorolac (K) administered intravenously was studied in ambulatory patients undergoing diagnostic gynecologic laparoscopy. METHODS: Patients were randomized to a treatment group A (n=30) and control group B (n=30). Intraoperatively group A received 30 mg of IV (K). Anesthesia management, postoperative pain and management of nausea were standardized in the two groups. Postoperative pain in group A was treated with 15 mg of IV (K) up to 2 times then with incremental doses of 25 mcg of fentanyl if indicted. Control group B received only incremental doses of fentanyl 25 mcg IV. Nausea and vomiting were treated with droperidol or ondansetron. Pain and nausea assessment were done every 30 minutes in the PACU, at discharge, and at 24 hours after discharge using visual analog scale pain scores (VAS) as well as verbal pain score (VPS). Statistical data were analyzed using ANOVA, Boneferroni correction and chi-square test. P<0.05 was considered statistically significant. RESULTS: Postoperatively for the first hour in the PACU, VAS and VPS were statistically significantly lower in Group A (p<0.05). Similarly the severity of pain was twofold less in Group A than in the control group. Significantly, less fentanyl was required in Group A than in the control group (p<0.05). The incidence of vomiting requiring treatment was twofold higher in the control group. The average discharge time from PACU was shorter in Group A (135 +/- 20 min) versus control (157 +/- 30 min). DISCUSSION: Intraoperative administration of (K) reduced the number of patients awakening in pain and significantly decreased the need for opioid analgesic in the postoperative period. In addition the incidence of vomiting, requiring treatment, was significantly lower in this group. (K) given intravenously intraoperatively is an effective alternative to opioids for the control of postoperative pain in patients undergoing gynecologic laparascopy.