Addition Of Ketorolac Research Articles

Addition of Ketorolac to Local Anesthesia for Wound Infiltration in Multilevel Posterior Lumbar Spinal Fusion: A Randomized, Double-Blinded, Placebo-controlled Trial.

Randomized double-blind controlled trial. The purpose of this study was to determine the efficacy of pain control and opioid consumption after administration of ketorolac directly to paraspinal muscle after spinal fusion. Ketorolac is added to multimodal analgesia regimens to improve pain control, reduce opioid consumption following Orthopaedics and spine surgery. However, evidence of efficacy of adding ketorolac to local anesthesia for intrawound infiltration after spine surgery is still limited. The patients who underwent multilevel lumbar decompression and posterolateral fusion were recruited and randomized to the control group which received 0.5% bupivacaine hydrochloride injected into paraspinal muscles before wound closure, and the ketorolac group which received 30mg ketorolac in addition to 0.5% bupivacaine hydrochloride. Post-operative numerical rating scale (NRS) for back pain, leg pain, morphine consumption, and adverse events were recorded. A total of 47 patients were randomized (24 in the ketorolac group and 23 in the control group). The mean age was 60.9±6.9 years old. The mean NRS for back pain at 6 hours after surgery was 5.8±3.0 points for the control group and 3.3±2.1 points for the ketorolac group (P<0.01). The ketorolac group consumed lesser morphine than the control group by 9.1mg in the first 24 hours, 13.8mg at 48 hours, 14.3mg at 72 hours, and 13.9mg at 96 hours after the surgery (P<0.05). Post-operative complications were not different between the two groups. The addition of ketorolac to bupivacaine for wound infiltration after posterior lumbar spine decompression and fusion reduces early post-operative pain and total morphine consumption as compared to bupivacaine alone.

Synergistic use of anti-inflammatory ketorolac and gentamicin to target staphylococcal biofilms

BackgroundWhile antibiotics remain our primary tools against microbial infection, increasing antibiotic resistance (inherent and acquired) is a major detriment to their efficacy. A practical approach to maintaining or reversing the efficacy of antibiotics is the use of other commonly used therapeutics, which show synergistic antibacterial action with antibiotics. Here, we investigated the extent of antibacterial synergy between the antibiotic gentamicin and the anti-inflammatory ketorolac regarding the dynamics of biofilm growth, the rate of acquired resistance, and the possible mechanism of synergy.MethodsControl (ATCC 12600, ATCC 35984) and clinical strains (L1101, L1116) of Staphylococcus aureus and Staphylococcus epidermidis with varying antibiotic susceptibility profiles were used in this study to simulate implant-material associated low-risk and high-risk biofilms in vitro. The synergistic action of gentamicin sulfate (GS) and ketorolac tromethamine (KT), against planktonic staphylococcal strains were determined using the fractional inhibitory concentration measurement assay. Nascent (6 h) and established (24 h) biofilms were grown on 316L stainless steel plates and the synergistic biofilm eradication activity was determined and characterized using adherent bacteria count, minimum biofilm eradication concentration (MBEC) measurement for GS, visualization by live/dead imaging, scanning electron microscopy, gene expression of biofilm-associated genes, and bacterial membrane fluidity assessment.ResultsGentamicin-ketorolac (GS-KT) combination demonstrated synergistic antibacterial action against planktonic Staphylococci. Control and clinical strains showed distinct biofilm growth dynamics and an increase in biofilm maturity was shown to confer further resistance to gentamicin for both ‘low-risk’ and ‘high-risk’ biofilms. The addition of ketorolac enhanced the antibiofilm activity of gentamicin against acquired resistance in staphylococcal biofilms. Mechanistic studies revealed that the synergistic action of gentamicin–ketorolac interferes with biofilm morphology and subverts bacterial stress response altering bacterial physiology, membrane dynamics, and biofilm properties.ConclusionThe results of this study have a significant impact on the local administration of antibiotics and other therapeutic agents commonly used in the prevention and treatment of orthopaedic infections. Further, these results warrant the study of synergy for the concurrent or sequential administration of non-antibiotic drugs for antimicrobial effect.

Analgesic effect of ketorolac as an adjuvant to bupivacaine in ultrasound-guided pectoral nerve block (I + II) for patients undergoing modified radical mastectomy: A randomized controlled clinical trial.

Many drugs have been tried as adjuvant to local anesthetic in different nerve blocks. Ketorolac is one of them, but it has never been used in pectoral nerve block. In this study, we evaluated its adjuvant effect with local anesthetic on postoperative analgesia in ultrasound (US)-guided pectoral nerve (PECS) blocks. The aim was to assess the quality and the duration of analgesia by the addition of ketorolac in the PECS block. 46 patients who underwent modified radical mastectomies under general anesthesia were randomized into two groups: control group, where pectoral nerve block was given with bupivacaine 0.25% only; and ketorolac group, where the block was given with bupivacaine 0.25% and ketorolac 30 mg. Patients who needed postoperative supplemental analgesia were significantly less in the ketorolac group (9 vs 21 patients, P = 0.00) and that first-time analgesic requirement was significantly later in the ketorolac group (14 hrs) postoperatively compared to the control group (9 hrs) postoperatively. Adding ketorolac to bupivacaine in pectoral nerve block safely increases postoperative duration of analgesia.

Comparison of intra-articular injection of local anaesthetic Ropivacaine versus Ropivacaine+Ketorolac and Ropivacaine+Tramadol for post-operative pain relief in knee and hip arthroplasty surgeries under spinal anaesthesia

Local anaesthetic infiltration in knee and hip arthroplasty is employed as a part of multi-model analgesia to reduce opiate consumption and help in early ambulation of elderly people It reduces post-operative pain effectively and thus reduces complications like Deep vein thrombosis, pulmonary embolism, pneumonia and even myocardial infection. Addition of ketorolac or Tramadol further prolongs the duration of analgesia. To compare the local anaesthetic infiltration of Ropivacaine alone and Ropivacaine with Ketorolac and Ropivacaine with tramadol for postoperative pain relief in knee and hip arthroplasty. Randomize double-blind study was conducted on 60 patients undergoing knee or hip arthroplasty under spinal anaesthesia. Group A patients received wound infiltration with Inj. Ropivacaine0.75% 50ml (5-7 mg/kg), Group B patients received Inj. Ropivacaine 0.75% 50 ml+1ml Inj. Ketorolac(30 mg) and Group C patients received Inj Ropivacaine 0.75% 50 ml+ Inj Tramadol 2ml (100mg), all diluted with NS to make 100 ml infiltration. Post-operative pain scores, time of first rescue analgesia (FRA), hemodynamic parameters and total rescue analgesic consumed in 24 hrs. as Inj Diclofenac and Tramadol was assessed and any untoward incidences like nausea, vomiting, knee swelling &amp; Hypotension etc. were noted. The VA Score was significantly lower in Grp C as compared to Grp B and A in first 4-6 hrs. as tramadol and ketorolac significantly prolongs the duration of analgesia. VA score in Grp Cis 3.8+_0.52, as compared to 4.02 ± 1.58 in Grp B and 5.7 ± 1.014 in Grp A. which was statistically significant (P value 0.0141). The time of first rescue analgesia (FRA) was also prolonged by 2.2 hrs. in Grp C as compared to Grp B and C which is statistically significant. (P value 0.003). The total rescue analgesia in 24 hrs. given as Inj Diclofenac and Inj Tramadol was significantly lower in Grp C as compared to Grp B and A. No of pts requiring rescue analgesia was also less 45% in Grp C as compared to 50% and 95% in Grp B and A respectively. 25% pts in Grp C has excellent pain relief as compared to 20% in Grp B and 10% in Grp A. No untoward effect like nausea vomiting is noted in any patient, only 3 pts in Grp A and 2 pts in Grp B required bl transfusion. Local infiltration of Ropivacaine provides good analgesia. Addition of tramadol or Ketorolac prolongs the analgesic effect of Ropivacaine and lowers the VAS significantly and improves patient satisfaction score. It also decreases post-operative 24hrs NSAID or opioid consumption.

A novel strategy for ketorolac detection based on turn-on plasmonic enhanced FRET synchronous fluorometric sensor employing micellized chitosan/ AgNPs nanocomposites: Preparation and mechanism investigation

A novel green eco-friendly turn-on FRET sensing strategy was developed for detection of ketorolac (KET). One-pot water-dispersed chitosan stabilized silver nanoparticles (AgNPs) solution was synthesized by complexation of micellized chitosan solution with silver nitrate at low temperature followed by subsequent reduction using sodium borohydride at 70 °C. The preparation method was mild and produced AgNPs solution stable for eight months at 4 °C. Owing to the spectral overlap of the fluorescent spectrum of chitosan and absorption spectrum of AgNPs, a novel sensitive turn-on FRET sensing strategy was established based on enhancement of chitosan fluorescence by electrostatic destabilization of the monodispersed AgNPs upon the addition of KET. The sensor solution was applied for the selective detection of ketorolac from 0.05 to 0.4 μM in injection dosage forms and spiked environmental water samples with no interference either of the KET photocatalyzed degradation product or other interfering structurally related or coexisting substances. The developed strategy showed promising results and could be applied practically for the detection of KET in injection dosage forms and environmental water.

Addition of ketorolac to local anesthesia for wound infiltration before closure in multilevel posterior lumbar spinal fusion: A randomized controlled trial

Addition of ketorolac to local anesthesia for wound infiltration before closure in multilevel posterior lumbar spinal fusion: A randomized controlled trial

Adjuvant interventions with opioids for vaso-occlusive crisis in sickle cell disease: A mixed treatment network meta-analysis of randomized controlled clinical trials.

Vaso-occlusive crisis is the most common clinical feature requiring opioid analgesics in patients with sickle cell disease. We conducted a network meta-analysis to compare the drugs that can be used as add-on with opioids for vaso-occlusive crisis. Network meta-analysis of randomized clinical trials. Sickle cell disease patients with vaso-occlusive crisis receiving adjuvants to opioids for pain management. A number of patients with complete pain relief and pain scores assessed either by visual ana-log or by a numerical rating scale were the primary outcomes. Adverse events and dose of opioids (in morphine equiva-lents) for pain alleviation between the treatment arms were the secondary outcome measures. Eleven studies evaluating the addition of ketorolac, magnesium sulfate, ketoprofen, ibuprofen, methadone, inhalational nitric oxide, methylprednisolone, and arginine with morphine were obtained. The pooled analysis showed a favorable effect in the pain reduction for the additions of arginine {-2 [-3.39, -0.61]} and ibuprofen {-1.7 [-3.26, -0.14]} with morphine. Arginine has high probability of being the "best" in the pool followed by ibuprofen. No significant differ-ences were observed in the risk of adverse events {ketoprofen-0.84 [0.42, 1.65]; magnesium sulfate-1.81 [0.64, 5.81]; and arginine-2.08 [0.18, 24.31]}. A significant lower dose of opioid was required when given adjunctive to argin-ine, inhalational nitric oxide, and methylprednisolone. We observed that arginine and ibuprofen could produce additional analgesic effects when combined with morphine in vaso-occlusive crisis.

A Prospective Randomized Study Evaluating the Effect of Perioperative NSAIDs on Opioid Consumption and Pain Management After Ankle Fracture Surgery

Category: Trauma Introduction/Purpose: Currently there is an epidemic in the United States regarding opioid abuse. This has resulted in strict government prescribing regulations throughout the country and increasing efforts by orthopaedic surgeons to better manage postoperative narcotic analgesia. Non-steroidal anti-inflammatory drugs (NSAIDs) can serve as a powerful adjunct in managing postoperative pain and in turn minimize the need for opioid medications. It has recently been shown that ketorolac can be used after open reduction and internal fixation (ORIF) of ankle fractures without interfering with bone healing. Therefore, we set out to evaluate whether including ketorolac in the postoperative drug regimen reduces opioid consumption and pain after ORIF of ankle fractures. Methods: 128 patients undergoing ORIF of an ankle fracture were prospectively randomized to treatment with or without ketorolac. Patients also had the option to simultaneously undergo regional anesthesia. Patients assigned to the treatment group were given 30 mg of IV ketorolac intraoperatively; prescribed 20 tablets of ketorolac 10 mg PO Q6 H and 30 tablets of Oxycodone/Acetaminophen 5/325 Q4-6 H PRN. Patients assigned to the control group were given 30 tablets of oxycodone/acetaminophen 5/325 Q4-6 H PRN only. A survey was distributed via Research Electronic Data Capture (REDCap) on postoperative days 1-7. Patients were asked to report their daily opioid consumption, pain level using the Visual Analog Scale (VAS), satisfaction with pain management, and side effects. Intention-to-treat analysis was performed. Normality of data was tested using the Shapiro-Wilk test. Differences between the control and treatment groups were tested using Mann-Whitney U or Student’s t-tests. Results: 105/128 (82%) patients with mean BMI of 29.3 completed all study requirements. 54 received ketorolac with opioid medication and 51 received opioids alone. 43 men (41%) and 62 women (59%) participated with mean age of 48 years. Patients receiving ketorolac required less oxycodone/acetaminophen (p&lt;0.013) and reported less pain (p&lt;0.048) during postoperative days 1 and 2 compared to control patients(Figure 1). While opioid consumption did not significantly differ after day 2, patients treated with ketorolac maintained less pain (days 1-4, p&lt;0.028); better sleep (days 1-5, p&lt;0.037); lower frequency of pain (days 1-3; p&lt;0.017); and greater satisfaction with pain management (days 1-3, p&lt;0.047). Hypersensitivity was significantly less on day 1 (p=0.036) and paresthesias on day 3 (p=0.011). Surprisingly, there was no difference in nausea/constipation between groups (p&gt;0.139). Conclusion: The addition of ketorolac to the postoperative drug regimen significantly reduced pain, while decreasing the use of opioid medication following ORIF of ankle fractures early in the postoperative period. Better pain management during postoperative days 1 and 2 is particularly important because patients on average consume the most opioids during this time. With the assurance that ketorolac does not interfere with bone healing, this NSAID is a valuable tool for helping patients manage postoperative pain with less narcotic analgesia.

46 - Impact of a Multi-Modal Pain Management on Pain Outcomes for Adolescents Undergoing Posterior Spinal Fusion

BACKGROUND CONTEXT: Approximately 10,000 US adolescents undergo posterior spinal fusion (PSF) annually for adolescent idiopathic scoliosis (AIS), but the role of adjuvant (nonopioid) medications are controversial. There is growing evidence regarding the role of nonopioid medications, such as ketorolac (NSAID) and GABA-analogues (GABA) in postoperative pain management, for decreasing opioid side effects and improving pain outcomes. However, no clear pediatric data are currently available regarding effectiveness, dosage, and timeframe for use. This study demonstrates that the addition of ketorolac or gabapentin to standard opioid-based analgesia improves mean pain scores on postoperative days 1 and 2, and reduces opioid requirements in adolescents undergoing PSF for AIS.

Analgesic effects of ketorolac/lidocaine compared to dexmedetomidine/lidocaine in intravenous regional anesthesia

Introduction: Intravenous regional anesthesia is known as a safe and reliable technique for anesthesia and reduction of bleeding during limb surgeries. The aim of this study is to compare the addition of ketorolac or dexmedetomidine to lidocaine in intravenous regional anesthesia. Materials and Methods: In this double-blind clinical trial, ninety patients who were admitted for surgery on hand or forearm in Vali-Asr Hospital, Arak city, entered the study. Then, the patients divided into three equal groups. The first group received 3 mg/kg lidocaine 0.5%, the second group received 1 μg/kg dexmedetomidine with lidocaine, and the third group received 30 mg ketorolac with lidocaine. The time to analgesia, pain during surgery, onset of pain after tourniquet deflation, and the pain after tourniquet deflation were measured. Results: The mean duration to analgesia was 7.37 ± 0.67 min in control group, 5.23 ± 0.68 min in dexmedetomidine group, and 4.90 ± 0.76 min in ketorolac group (P = 0.164). In total of 3 times of measurement of pain after injection, the mean visual analog scale in ketorolac group was significantly lower than lidocaine (P = 0.0001) and dexmedetomidine (P = 0.009) groups. In all time intervals after tourniquet deflation, the mean score of pain was significantly lower in ketorolac group. Conclusion: Ketorolac could control the perioperative pain and the pain after tourniquet deflation. It seems that ketorolac is a useful and effective choice for pain relief for patients undergoing intravenous regional anesthesia.

The Impact of Non-Steroidal Anti-Inflammatory Agents after Phacoemulsification on Quality of Life: A Randomized Study.

IntroductionThe purpose of our study was to investigate the impact of ketorolac addition to the well-established combination of antibiotic-steroid agent in terms of vision-related quality of life.MethodsPatients were randomized to: (1) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid (n = 68) and (2) fixed combination of tobramycin 0.3%–dexamethasone 0.1%, one drop qid, plus ketorolac tromethamine 0.5%, one drop tid (n = 70). All patients completed the VFQ-25 questionnaire to assess their functional vision before cataract surgery and postoperatively on days 7, 28 and 42. The statistical analysis comprised the point-wise comparison between the two groups at the four time points for all sub-scales of the VFQ-25 questionnaire, as well as the composite score.ResultsNo significant differences were noted regarding the composite score, as well as all subscales in all examined time points.ConclusionsThe addition of ketorolac did not seem to offer any additional benefit in terms of vision-related quality of life.

Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients.

In this retrospective analysis of 10,575 patients who used fentanyl-based intravenous patient-controlled analgesia (IV-PCA) after surgery, we evaluated difference between young and elderly patients on their characteristic of adverse effects.We reviewed the data collected from the patients who were provided IV-PCA for pain control following elective surgery under either general or spinal anesthesia between September 2010 and March 2014. Postoperative pain, incidence of PCA-related adverse effects, and risk factors for the need of rescue analgesics and antiemetics for postoperative 48 hours were analyzed.Pain intensity (numerical rating scale [NRS]) at postoperative 6 to 12 hours (4.68 vs 4.58, P < 0.01) and incidence of nausea or vomiting (23.8% vs 20.6%, P < 0.001) were higher in young patients, while incidence of PCA discontinuation (9.9% vs 11.5%, P < 0.01) and sedation (0.1% vs 0.7%, P < 0.001) was higher in elderly patients. Despite larger fentanyl dose used, a greater proportion of young patients required rescue analgesics (53.8% vs 47.9%, P < 0.001) while addition of ketorolac was effective in reducing postoperative pain. Despite lower incidence of postoperative nausea and vomiting (PONV), a larger proportion of elderly patients required rescue antiemetics (10.1% vs 12.2%, P < 0.001) while addition of ramosetron was effective in reducing PONV.In conclusion, when fentanyl-based IV-PCA is used for postoperative pain control, a larger proportion of young patients may require rescue analgesics while elderly patients may require more rescue antiemetics. The addition of ketorolac or ramosetron to the PCA of young and elderly patients can be effective to prevent rescue analgesics or antiemetics use.

Local infiltration analgesia for total knee arthroplasty: should ketorolac be added?

BackgroundAdequate postoperative analgesia with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee arthroplasty (TKA). High-volume local infiltration analgesia (LIA) with ropivacaine has been introduced, but effects of adjuvants are still debated. We tested the hypothesis that the addition of ketorolac to LIA significantly improves analgesia after TKA. MethodsSixty patients undergoing TKA were randomized to receive intraoperative LIA (ropivacaine 300 mg and epinephrine 0.5 mg) combined with either ketorolac 30 mg (ketorolac group) or saline (control group). After surgery, eight bolus doses of ropivacaine 100 mg combined with either ketorolac 15 mg (ketorolac group) or saline (control group) were administered every 6 h via an intra-articular catheter. The primary outcome was postoperative consumption of i.v. morphine patient-controlled analgesia (PCA). Secondary outcomes were time to first request of i.v. morphine PCA, pain intensity, side-effects, and readiness for hospital discharge. ResultsConsumption of i.v. morphine PCA was lower in the ketorolac group vs control group {0–6 h: 0 (0–0) vs 5 (0–10) mg, P<0.0001; 0–48 h: 10 (0–22.5) vs 48.75 (30–82.5) mg, P<0.0001 [median (inter-quartile range, IQR)]}. Time to first request of i.v. morphine PCA was longer in the ketorolac group vs the control group [490 (248–617) vs 223 (115–319) min, P=0.02, median (IQR)]. Early postoperative pain (<48 h) and readiness for hospital discharge were also significantly reduced in the ketorolac group. ConclusionsLIA with ketorolac results in reduced morphine consumption, reduced pain intensity, and earlier readiness for hospital discharge.

Contributions of nitric oxide and prostaglandins to exercise hyperemia in young obese adults

Nitric oxide (NO) and prostaglandins (PGs) play important roles in exercise hyperemia in healthy humans, but the role of NO &amp; PGs in young obese (OB) adults is currently unknown. We hypothesized the relative contribution of NO and PGs to exercise hyperemia would be lower in young OB adults when compared to lean adults. 11 healthy lean (27±2yrs, BMI=23±1) and 7 OB adults (23±2yrs, BMI=38±4) performed two 10‐minute trials of dynamic forearm exercise (20 contractions/minute) at 15% of maximal voluntary contraction. A brachial artery catheter was used for local infusion of the NO synthase inhibitor, L‐NMMA, alone or in combination with the cycloxygenase inhibitor, ketorolac. L‐NMMA or ketoroloac was infused during the last 5 minutes of each exercise trial to achieve single and double blockade respectively. Forearm blood flow (FBF) was measured using Doppler ultrasound, and forearm vascular conductance (FVC) was calculated (FBF÷BP=FVC). From steady state exercise, the relative change in FVC with L‐NMMA was similar between groups (Lean−34±10 vs. OB−35±15%). With the addition of ketorolac, the relative change in FVC was opposite between groups (Lean−7±8 vs. OB+30±17%, p=0.02). We conclude the contribution of NO to exercise hyperemia appears intact in young OB adults, although they may produce more vasoconstrictor PGs that alter blood flow regulation. Support: NIH R01 HL105820.

Postoperative Subcutaneous Instillation of Low-Dose Ketorolac But Not Hydromorphone Reduces Wound Exudate Concentrations of Interleukin-6 and Interleukin-10 and Improves Analgesia Following Cesarean Delivery

The objectives of this study were to test the effects of low-dose ketorolac and hydromorphone added to continuous local anesthetic wound instillation on surgical-site inflammatory mediators, postoperative pain, and opioid consumption. Sixty healthy women undergoing cesarean delivery were enrolled in this randomized, double-blinded study. Patients were randomized to receive a subcutaneous wound instillation of bupivacaine .5% at 10 mg/hour (active control), bupivacaine .5% with ketorolac .6 mg/hour, or bupivacaine .5% with hydromorphone .04 mg/hour for 48 hours postcesarean. Wound exudate was sampled at 4, 24, and 48 hours postcesarean and assayed for interleukins IL-1β, IL-2, IL-6, IL-8, IL-10, and IL-12, tumor necrosis factor (TNF-α), interferon (INF-γ), and granulocyte-macrophage colony stimulating factor (GM-CSF). The addition of ketorolac to bupivacaine significantly decreased IL-6 (P = .012) and IL-10 (P = .005) compared to plain bupivacaine. Ketorolac, but not hydromorphone, was associated with a decrease in pain (P = .018) and analgesic use (P = .020) following cesarean delivery. Our results are compatible with the view that significant analgesics effects are mediated through local modulation of inflammatory events. Low-dose ketorolac administered into surgical wounds exert significant anti-inflammatory and analgesic effects and may be a valuable analgesic alternative to systemic nonsteroidal anti-inflammatories (NSAIDs) but with potentially fewer side effects. PerspectiveThis article demonstrates that low-dose ketorolac administered into wounds modulates local inflammatory events, decreases postoperative pain, and reduces opioid consumption. These results suggest that administration of NSAIDs into surgical wounds may be an analgesic alternative to higher systemic dosing of NSAIDs.

Comparison between ropivacaine local infiltration analgesia with ketorolac or placebo for total knee replacement surgery

Abstract Background/aims Optimal pain treatment with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee replacement surgery. Local infiltration analgesia (LIA) with local anaesthetic might be effective and adjuncts such as ketorolac may provide additional effects on opioid requirements and pain. We tested the hypothesis that adding ketorolac significantly improves analgesia after total knee replacement surgery. Methods Sixty patients were enrolled in this prospective double-blinded study and allocated to either group R (placebo) or Group RK (ketorolac 120 mg). All patients received high-volume LIA with 150 ml ropivacaine (300 mg) with epinephrine added either placebo or ketorolac (30 mg) combined with eight 10 ml ropivacaine doses (100 mg) added either placebo or ketorolac (15 mg) administered every 6 h through an intra-articular catheter for 48 h. postoperatively. The primary outcome was patient-controlled morphine consumption from 0–6 and 0–48 h after surgery. Time to first rescue administration, pain intensity (0–100 mm visual analogue scale) at rest and during mobilization and side-effects were recorded until 96 h after surgery. Results Six and forty-eight morphine consumption was significantly reduced in group RK compared with group R. Time to first rescue analgesia was significantly prolonged with 4 h in group RK [median (IQR)] 490 min (248–617) compared with 223 min (115–319) group R (P &lt; 0.02). Pain at rest and during movement was significantly reduced for 48 h with the addition of ketorolac. Length of hospital stay was reduced with one day in group RK [median (IQR)] 2 days (2–3) compared with group R3 days (2–3) (P =0.004). Conclusions Ketorolac resulted in a 75% reduction in 48 h postoperative morphine requirements. This was also significantly associated with prolonged analgesia, reduced pain intensity scores at rest and during movement and reduced length of hospital stay.

Rapid analgesic onset of intra-articular hyaluronic acid with ketorolac in osteoarthritis of the knee

The purpose of this study was to evaluate the efficacy of intra-articular ketorolac to improve intra-articular hyaluronic acid (HA) therapy in knee osteoarthritis with respect to the initiation of pain relief. This study was designed as a single-blind study with a blinded observer and a 3-month follow-up. Forty-three patients with knee osteoarthritis were randomized to the ketorolac group (n=21) or the HA group (n=22). Ketorolac group members were given three weekly intra-articular injections of HA with ketorolac and then two weekly intra-articular injections of HA; and HA group members were given five weekly intra-articular HA injections. Visual analog scale (VAS), pain rating score (PRS) and adverse events were assessed at baseline and at 1st, 3rd, 5th, and 16th week after treatment commencement. Significant improvement regarding pain assessment tools was observed in the ketorolac group by the addition of ketorolac to HA as compared with the HA group within 16 weeks of follow-up (p < 0.05). In the ketorolac group, 5 of the 21 subjects developed focal post-injection knee pain for about 8 hours after injection. Intra-articular HA with ketorolac showed more rapid analgesic onset than intra-articular HA alone and did not induce any serious complications.

Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

Background/Aims: To evaluate the benefit of adding a nonsteroid agent to an antibiotic/steroid combination after uneventful phacoemulsification, adopting a weekly follow-up, to gain insight into the optimal duration of postoperative treatment and to examine whether risk factors for inflammation exist. Methods: Patients were randomized to (i) tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d. (n = 72), and (ii) a combination of tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d., plus ketorolac tromethamine 0.5%, 1 drop t.i.d. (n = 73). On days 7, 14, 21 and 28, the frequency of inflammation-related signs (corneal edema, conjunctival hyperemia, anterior chamber or Tyndall reaction) as well as best-corrected visual acuity (BCVA) were measured. On day 21, logistic regression was performed to evaluate risk factors for inflammation. Results: The frequency of inflammation-related signs did not differ between the 2 groups at any time point, neither did BCVA. On day 21, pseudoexfoliation was associated with the presence of any inflammation-related sign (OR = 4.5; 95% CI: 1.2–16.0; p = 0.022). No evidence of clinically significant cystoid macular edema became evident in either group. Conclusion: The addition of ketorolac did not seem to offer any additional benefit in terms of inflammation-related signs. Four weeks appeared as an adequate treatment interval. Special attention should be paid to patients with pseudoexfoliation.

Determination of Independent Risk Factors Associated with Nausea and Vomiting Induced by Intravenous Tramadol Patient-controlled Analgesia after Spine Surgery

Background: Nausea and vomiting are common side effects of tramadol. We conducted a retrospective study to identify the risk factors associated with nausea and vomiting induced by intravenous (IV) tramadol patient-controlled analgesia (PCA). Methods: Four hundred and sixty-one patients who received intravenous tramadol PCA after spine surgery were enrolled in our retrospective study. Patients' demographics, total doses of tramadol administered, and types of adjuvant agents including metoclopramide pretreatment and addition of ketorolac to the PCA solution were recorded. Associations between individual variables and the IV tramadol PCA-induced nausea and vomiting were analyzed statistically. Further logistic regression analysis was used to determine the independent risk factors of each variable. Results: The independent risk factor associated with IV tramadol PCA-induced nausea and vomiting was female gender (adjusted odds ratio [OR] 2.5, 95 % confidence interval [CI] 1.4-4.6). The addition of ketorolac to PCA solution resulted in decreased nausea and vomiting (adjusted OR 0.4, 95% CI 0.2-0.7). Conclusions: Our study demonstrated that, after spine surgery, females could be associated with IV tramadol PCA-induced nausea and vomiting, and that addition of ketorolac to the PCA solution might decrease its incidence. These findings suggest that adding ketorolac to tramadol PCA solution may help in the management of IV tramadol-induced nausea and vomiting after spine surgery.

Opioid-sparing Effects of Ketorolac and Its Correlation With the Recovery of Postoperative Bowel Function in Colorectal Surgery Patients

Postoperative ileus (PI) is one of many common complications in major abdominal surgery. PI results in patient discomfort, increased gastrointestinal leakage, prolonged hospital stay, and increased medical expenses. In this study, we have investigated the morphine-sparing effects of ketorolac and its correlation with the duration of PI in patients with colorectal surgeries. We collected data from 102 patients who had received elective colorectal resection. The patients were randomly allocated into 2 groups and received intravenous patient-controlled analgesia (IVPCA) morphine (M group) or IVPCA morphine plus ketorolac (M+K group). Time-scale morphine consumption (per 12 h), recovery of bowel functions (the first bowel movement and passage of flatus), pain scores, and opioid-related side effects were then recorded. Patients in the M+K group received 18.3% less morphine than those in the M group within 72 postoperative hours. The maximal opioid-sparing effects of ketorolac appeared in 12 to 24 postoperative hours. The onset of the first bowel movement and passage of flatus was significantly less in the M+K group than in the M group. The M group showed a 5.25 times greater risk of inducing PI, a result comparable with the M+K group in colorectal surgery patients. The addition of ketorolac to IVPCA morphine has demonstrated a clear opioid-sparing effect and benefits in regards to the shortening of the duration of bowel immobility. We suggest that adding ketorolac to morphine IVPCA be included in the multimodal postoperative rehabilitation program for the early restoration of normal bowel function.