MP41-01 A RANDOMIZED DOUBLE-BLINDED PLACEBO CONTROLLED STUDY EVALUATING THE EFFICACY OF INTRA NASAL KETOROLAC IN TREATING POST-OPERATIVE PAIN IN AMBULATORY URETEROSCOPIC SURGERY

Abstract

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-01 A RANDOMIZED DOUBLE-BLINDED PLACEBO CONTROLLED STUDY EVALUATING THE EFFICACY OF INTRA NASAL KETOROLAC IN TREATING POST-OPERATIVE PAIN IN AMBULATORY URETEROSCOPIC SURGERY Kara L. Watts, Nair Singh, Amaresh Vydynathan, Irene Kho, Zhenmei Zhang, David M. Hoenig, and Joshua Stern Kara L. WattsKara L. Watts More articles by this author , Nair SinghNair Singh More articles by this author , Amaresh VydynathanAmaresh Vydynathan More articles by this author , Irene KhoIrene Kho More articles by this author , Zhenmei ZhangZhenmei Zhang More articles by this author , David M. HoenigDavid M. Hoenig More articles by this author , and Joshua SternJoshua Stern More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1629AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopic stone extraction (URS) is a common urologic surgery. Post operative pain management after URS remains a major factor delaying discharge of patients and adding morbidity at home. We investigated whether the intraoperative use of intranasal ketorolac, recently approved by the FDA, affected post operative opioid requirement and pain control in patients undergoing URS. METHODS IRB approval was obtained to conduct a prospective, double-blinded, placebo-controlled trial. Patients undergoing URS at one institution were consented and randomized to receive either the study drug or placebo. Routine anesthesia and surgical care were administered to all patients. Fifteen minutes before the end of surgery, one spray of either the study drug (15.75 mg) or saline spray (placebo) was delivered to each nostril. Patient-reported numeric pain scores (NRS) at baseline (pre-op) and at 30 minutes, 1, 2, and 3 hours post-op were analyzed. The amount of opioid medication administered post-op was also assessed. Adverse events were assessed, and an anesthesia satisfaction survey was administrated at the time of discharge. Median NRS pain scores and opioid consumption between the groups were analyzed using Mann-Whitney-Wilcoxon test. RESULTS Fifty subjects were enrolled; 4 were removed from the analysis due to enrollment outside of the protocol guidelines, yielding 23 patients in each study group. There were no differences between the study or placebo groups for baseline demographics or intra-operative parameters. There were no differences between the NRS pain scores at baseline and at all post-op assessments. There was no difference between groups for average post-op IV morphine equivalence opioid consumption at all time points. Additionally there was no difference in the percent of subjects discharged at 3 hours after the surgery (63.2% vs 72 %, p = 0.55). The most common adverse event reported at 24 hours was stuffy nose and was similar between the groups. CONCLUSIONS Ketorolac is a common medication utilized for post-operative analgesia in ambulatory urologic procedures. The intranasal formulation is newly approved and easy to administer. Our results indicate that this formulation does not appear to affect patient-reported post operative pain, opioid requirement, or time to discharge after URS. As such use of the intranasal NSAIDS may not be effective in patients undergoing URS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e500 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kara L. Watts More articles by this author Nair Singh More articles by this author Amaresh Vydynathan More articles by this author Irene Kho More articles by this author Zhenmei Zhang More articles by this author David M. Hoenig More articles by this author Joshua Stern More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...