Intramuscular Ketorolac Research Articles

A comparison of the effect of intramuscular diclofenac, ketorolac or piroxicam on post-operative pain following laparoscopy

Sixty patients presenting for in-patient gynaecological laparoscopic surgery were randomly allocated to receive either diclofenac 75 mg (n = 20), ketorolac 30 mg (n = 20) or piroxicam 20 mg (n = 20) as an intra-muscular injection immediately after induction of anaesthesia. Postoperative visual analogue scores over the first 24 hours, using a 10 cm scale, ranged from 3.2-0.5 in the diclofenac group, 2.7-0.85 in the ketorolac group and 2.8-0.5 in the piroxicam group. The scores did not differ significantly between the three groups (p > 0.05). Mean time (SD) to first analgesia was 27(94) minutes in the piroxicam group, 16 (30) minutes in the diclofenac group and 62 (120) minutes in the piroxicam group. Six out of twenty patients in the diclofenac group required further analgesia compared to nine out of twenty in the other two drug groups. This difference was not significant. There were no reports of increased bleeding, bronchoconstriction, bleeding from the upper gastrointestinal tract, renal impairment or pain from the intra-muscular injection site in any of the groups. The administration of a non-steroidal anti-inflammatory drug to patients presenting for laparoscopic surgery reduces postoperative pain. There were no obvious differences between the agents used.

Interaction of low molecular weight heparin with ketorolac

Postoperative patients may receive ketorolac, a nonsteroidal antiinflammatory drug that inhibits platelet function, for analgesia and may receive low-molecular-weight heparin (LMWH) for thrombosis prevention. We investigated whether the combination of these two agents increases blood loss in a rabbit model of hemostasis. In a randomized, blinded study, animals received either intramuscular ketorolac (0.5 mg/kg or 1.0 mg/kg) and subcutaneous saline solution, subcutaneous LMWH (100 U/kg) and intramuscular saline solution, ketorolac (0.5 mg/kg or 1.0 mg/kg) and subcutaneous LMWH (100 U/kg), or intramuscular and subcutaneous saline solution given 30 minutes before ear incision and measurement of blood loss. Collagen-induced platelet aggregation was examined and anti-Xa levels were determined by using a chromogenic substrate method. As compared with results in saline-treated controls, blood loss was significantly increased in animals receiving ketorolac in a dose of 1.0 mg/kg but not in those treated with 0.5 mg/kg. The addition of LMWH did not further increase blood loss above that observed with either dose of ketorolac alone. Platelet aggregation was inhibited by both doses of ketorolac. The anti-Xa levels in the LMWH-treated animals were comparable to those measured in patients receiving these agents for prophylaxis (0. 09 to 0. 13 U/ml). We conclude that in the rabbit model, LMWH does not augment ketorolacassociated bleeding when both agents are used in doses comparable to those given to human patients.

Does Patient-Controlled Analgesia Achieve Better Control of Pain and Fewer Adverse Effects Than Intramuscular Analgesia?

To compare three analgesic regimens in patients undergoing colon resection: patient-controlled morphine sulfate analgesia (PCA), intramuscular (IM) morphine, and IM ketorolac tromethamine. Prospective randomized case series. Rural, private teaching hospital. All patients (307) scheduled to undergo a major colon resection between January 1, 1992, and December 31, 1993, were eligible to participate. Of these, 10 (3%) were missed in the screening process, 132 (43%) declined participation, 73 (24%) were excluded, and 92 (30%) were enrolled and randomly assigned to a treatment group. Ninety-two patients were enrolled in the study. Two patients never received the medication to which they were assigned, owing to administrative error; their data was not analyzed. Of the remaining patients, 31 were randomized to the PCA morphine group, 31 were randomized to the IM morphine group, and 28 were randomized to the IM ketorolac group. The randomly assigned drug was first administered in the post-anesthesia care unit. On arrival on the postoperative ward, the patient was asked to rate his or her pain using both a numerical rating scale and a visual analog scale at 30 minutes; 1, 2, 3, 4, and 6 hours after arrival on the ward; and every 4 hours throughout the first 5 postoperative days. The Mini-Mental State Examination (MMSE) was administered the day before surgery and then daily for the first 5 postoperative days. The first day the patient passed flatus after surgery was also recorded. The end points analyzed were adverse effects, duration of postoperative ileus, degree of pain control, length of hospitalization, and development of postoperative confusion as measured on serial MMSEs. Only two patients, both in the PCA group, reported adverse effects; neither required a change in analgesia group. Significantly more patients assigned to IM ketorolac broke protocol and required alternative analgesia than did patients in the morphine groups (32% ketorolac vs 16% IM morphine and 0% PCA). The ketorolac group had a significantly shorter duration of ileus than either morphine group (P<.0l). The ketorolac group also had significantly lower pain scores (P<.04) and less postoperative confusion than the morphine groups (P<.03), although these results are limited by missing values. The ketorolac group had a significantly shorter length of stay than either morphine group (P<.01), while there was no significant difference between the morphine groups (P=.75). While it appears that ketorolac provides a better postoperative course than either IM or PCA morphine in terms of pain control, postoperative confusion, length of stay, and duration of ileus, 18% of our patients assigned to ketorolac required additional analgesia, and there was a strong patient preference for PCA. Most patients should probably be managed with PCA narcotics, but the addition of ketorolac might reduce narcotic dose and resultant adverse effects. Those patients particularly prone to adverse effects should receive primarily ketorolac.

Ketorolac Versus Meperidine for Pain Relief After Orthopaedic Surgery

In this double-blind, randomized, multicenter study, 244 patients with at least moderate pain after major orthopaedic surgery received intramuscular Ketorolac (60 mg followed by 30 mg) or intramuscular meperidine (100 mg or placebo) every 2 to 6 hours as needed for as many as 5 days. Analgesic response was evaluated for 6 hours after initial study drug administration and thereafter each night at bedtime. Both active treatment groups had similar 3-hour summed pain intensity difference and 3-hour total pain relief scores after the first dose that were superior to placebo. The 6-hour summed pain intensity difference and total pain relief scores were significantly higher with Ketorolac than with meperidine or placebo. The mean daily categorical pain intensity scores were comparable with Ketorolac and meperidine, and both were significantly superior to placebo. Patient ratings of overall medication efficacy were significantly better with Ketorolac than with meperidine. In both patient and observer evaluations, Ketorolac was significantly better tolerated than meperidine, and the number of patients reporting adverse events was lower with Ketorolac than with meperidine. Following major orthopaedic surgery, Ketorolac provided effective analgesia that was superior to placebo and at least comparable with meperidine. Ketorolac was better tolerated than meperidine.

Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial

Moderate to severe pain associated with the removal of pleural chest tubes is poorly controlled with opioids. New methods are needed to manage the pain associated with this procedure. To compare the effects of interpleural injections of 0.25% bupivacaine without epinephrine to those of normal saline on chest tube removal pain in cardiothoracic surgery patients. A randomized, double-blind, placebo-controlled trial was used, with a repeated measures design. Pain intensity and distress were measured before, immediately after, and 1 hour after chest tube removal. Pain sensations and affect were evaluated immediately after chest tube removal. The experimental group (n = 21) received bupivacaine and the control group (n = 20) received normal saline. In both groups pain intensity and distress scores were significantly higher at the time of chest tube removal than immediately before or 1 hour after. No significant differences in pain intensity, distress, sensation, or affect scores were found between the two treatment groups. The 13 patients who received intramuscular ketorolac an average of 3.5 hours before the procedure, independent of the study design, had significantly lower pain intensity scores at the time of chest tube removal than the 26 who did not. These data demonstrate that chest tube removal pain is of moderate to severe intensity and that pleural chest tube injections of bupivacaine were not effective in decreasing chest tube removal pain. However, the decrease in pain associated with the administration of ketorolac warrants future study.

The analgesic efficacy of ketorolac for acute pain

Ketorolac is a nonsteroidal anti-inflammatory drug, available in both oral and parenteral forms, that possesses significant analgesic potency. Its analgesic efficacy has been studied extensively for the treatment of moderate-to-severe pain in many clinical settings. Although ketorolac possesses significant analgesic potency, it has limited utility as an analgesic for the acute treatment of moderate-to-severe pain in the emergency department. Oral ketorolac has been shown to provide analgesia that is the same or better than aspirin, acetaminophen, and dextropropoxyphene with acetaminophen, and equal analgesia to most other commonly available oral analgesics, including ibuprofen and acetaminophen with codeine. Intramuscular ketorolac provides analgesia equivalent to commonly used doses of meperidine and morphine. However, its utility in acute pain, when rapid relief is necessary, is limited due to a prolonged onset to analgesic action (30–60 min) and a significant number of patients who exhibit little or no response, more than 25% in most studies. The use of intravenous ketorolac has been less well studied. It has analgesic potency but its utility in patients with moderate-to-severe pain is also limited because there is a significant percentage of patients who fail to obtain adequate relief. Ketorolac may be most useful in supplementing parenteral opiates.

Comparative Efficacy of Oral Ibuprofen Arginine and Intramuscular Ketorolac in Patients with Postcaesarean Section Pain

In this double-blind double-dummy placebo-controlled study. 92 patients from a single centre were randomly assigned to receive either ibuprofen arginine 400mg orally, ketorolac 30mg by intramuscular injection, or placebo, after caesarean section. Pain intensity was measured on a Visual Analogue Scale (VAS) ranging from 0 (no pain) to 100mm (unbearable pain) at 15, 30, 45, 60. 90, 120, 180, 240, 300, and 360 minutes after the administration of study medication.

Comparative Efficacy of Oral Ibuprofen Arginine and Intramuscular Ketorolac in Patients with Postoperative Pain

The comparative clinical efficacy and tolerability of ibuprofen arginine and ketorolac were determined in a study that used a double-blind double-dummy protocol. 124 patients who underwent surgical repair of inguinal hernia at a single medical centre were randomly assigned to receive either oral ibuprofen arginine 400mg, ketorolac 30mg by intramuscular injection or placebo. Pain intensity was assessed at baseline and at 15, 30, 45, 60, 90, 120, 180, 240, 300 and 360 minutes after medication administration, on a Visual Analogue Scale (VAS) ranging from no pain (0mm) to unbearable pain (100mm).

Randomized Double-Blind Comparison of the Analgesic Efficacy of Intramuscular Ketorolac and Oral Indomethacin in the Treatment of Acute Gouty Arthritis

Study objective: To compare the analgesic effect of IM ketorolac tromethamine with that of oral indomethacin in the treatment of acute gouty arthritis. Design: Prospective, randomized, double-blind, controlled, parallel group clinical trial. Setting: Two urban emergency departments. Participants: Twenty consecutive patients who presented to the ED with acute gout. Interventions: Each patient was randomly assigned to receive in the ED (1) 60 mg of IM ketorolac and oral placebo or (2) 50 mg of oral indomethacin and IM placebo. The patients rated the intensity of their pain on a Wong-Baker pain scale (which runs from 0 to 5) before treatment and 30, 60, 90, and 120 minutes after treatment. All the patients were discharged with instructions to take oral indomethacin and to complete pain score cards at home at 6, 12, and 24 hours. Results: The 10 patients in each group were similar with regard to age, sex, race, and initial mean pain score. After 2 hours, the mean pain scores (±SD) for the ketorolac group had decreased from 4.5±.71 to 1.4±1.43 ( P<.05), and the mean score for the indomethacin group had decreased from 4.4±.70 to 1.5±1.18 ( P<.05). The difference between the two groups was not significant. At 6 hours, there was some pain rebound in the ketorolac group. Conclusion: IM ketorolac and oral indomethacin are similar in the relief of the pain of acute gouty arthritis in the ED. [Shrestha M, Morgan DL, Moreden JM, Singh R, Nelson M, Hayes JE: Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis. Ann Emerg Med December 1995;26:682-686.]

Ketorolac for early postoperative analgesia

Study Objective: To determine the efficacy and speed of onset of analgesia of a single dose of intravenous (IV) or intramuscular (IM) ketorolac tromethamine following major orthopedic surgery. Study Design: Double-blind, randomized, placebo-controlled trial. Setting: A district general hospital in England. Patients: 112 patients aged 18 to 80 years suffering moderate or severe pain following orthopedic surgery. Interventions: Patients were randomized to receive 30 mg ketorolac IV, 30 mg ketorolac IM, or placebo following surgery. Measurements and Main Results: Verbal pain intensity scores were performed prior to admission to the study, then frequently for the first 45 minutes following administration of study medication, and subsequently at hourly intervals. Times to request for further analgesia were noted. Patient assessment of overall acceptability and pain relief of the study medication was recorded. There was no statistical difference in speed of onset of analgesia between the ketorolac groups and placebo. Median (range) times to first analgesic following study drugs were: ketorolac IV 45 minutes (9 to 1440 minutes), ketorolac IM 34 minutes (10 to 1440 minutes), placebo 24 minutes (10 to 615 minutes). There was a statistically significant difference between the ketorolac groups and placebo (ketorolac IV vs. placebo, p < 0.01; ketorolac IM vs. placebo, p = 0.03). Patient assessment of overall acceptability and pain relief was significantly better for IV ketorolac compared with placebo ( p < 0.01). By 6 hours, 78% of the IV ketorolac group and 95% of the IM ketorolac and placebo groups required further analgesia. Conclusions: Despite high patient acceptability compared with placebo, the use of ketorolac as the sole analgesic failed to control postoperative pain following major orthopedic surgery. IV administration of ketorolac conferred no advantages over the IM route with regard to efficacy or speed of onset.

Intramuscular Ketorolac Versus Oral Ibuprofen in Acute Musculoskeletal Pain

Study objective: To evaluate the efficacy of IM ketorolac versus that of oral ibuprofen in acute musculoskeletal pain. Design: Randomized, prospective, double-blind clinical trial. Setting: Urban teaching emergency department with an annual census of 43,000. Participants: Convenience sample of 82 patients aged 18 to 70 years with acute musculoskeletal pain due to trauma. Interventions: Forty-two subjects each received 60 mg ketorolac by IM injection and ingested a placebo capsule. Forty subjects each ingested 800 mg ibuprofen and received a placebo (saline) IM injection. Pain was evaluated with a 100-mm visual analog scale at baseline and 15, 30, 45, 60, 75, 90, and 120 minutes after dosing. The prevalence of side effects was elicited in each patient. Results: Mean pain scores improved in each group during the course of the study but did not significantly differ between groups at baseline or at any subsequent interval. The numbers of dropouts due to inadequate analgesia and prevalence of side effects in the two groups did not differ significantly. Conclusion: IM ketorolac and oral ibuprofen provide comparable analgesia in ED patients with acute musculoskeletal pain. [Turturro MA, Paris PM, Seaberg DC: Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain. Ann Emerg Med August 1995;26:117-120.]

Ketorolac (Toradol) and Acute Random-Pattern Skin Flap Survival in Rat

To assess the efficacy of sustained postoperative intramuscular ketorolac tromethamine (Toradol) at analgesic levels in the augmentation of acute, random-pattern skin flaps in rat. Prospective, randomized, placebo-controlled, animal trial. Animal research laboratory, School of Medicine, Oregon Health Sciences University, Portland. Forty-four adult male Sprague-Dawley rats (260 to 280 g). Twenty-two treatment animals underwent modified McFarlane random-pattern skin flaps followed immediately by intramuscular loading doses of ketorolac. Treatment animals were then maintained on a regimen of intramuscular ketorolac using a three times a day dosing schedule for 14 days postoperatively. Twenty-two control animals underwent identical modified McFarlane random-pattern skin flaps and were given equivalent volumes of intramuscular saline on the same dosing schedule for the 14-day treatment period. Postmortem measurements of skin flap ischemia (expressed as a percentage of total flap surface area) were performed for both treatment and control animals by three independent, non-blinded observers using the acetate tracing technique. Both pooled and individual data were statistically analyzed using personal computer software. Forty-three of the 44 animals successfully completed the experimental trial. One animal in the treatment group died on postoperative day 3 of unknown causes. During the study period, one postoperative hematoma was detected in both the treatment and control groups. The mean percentage of skin flap ischemic necrosis observed in control animals (35.4%) was consistently less than that measured in the treatment group (36.4%). However, the difference in ischemic flap necrosis between control and treatment groups was not statistically significant (P = .6919). Comparatively high-dose intramuscular ketorolac failed to augment acute, random-pattern skin flap survival in rat when initiated in the immediate postoperative period. Complications of prolonged, intramuscular ketorolac were not observed in this trial. Further studies using preoperative initiation of drug therapy may help to clarify the true efficacy of ketorolac in flap augmentation.

Reduction of pain and nausea after laparoscopic sterilization with bupivacaine, metoclopramide, scopolamine, ketorolac, and gastric suctioning

To determine whether postoperative pain and nausea after laparoscopic sterilization can be reduced with a combination of bupivacaine, metoclopramide, scopolamine, ketorolac, and gastric suctioning. Women undergoing outpatient laparoscopic sterilization were randomized to protocol management or nontreatment groups. Each patient received standard general endotracheal anesthesia. Protocol subjects received intramuscular ketorolac 60 mg and scopolamine 0.25 mg, intravenous metoclopramide 10 mg, and gastric suctioning; bupivacaine (2.5 mg/mL) with epinephrine (5 micrograms/mL) was injected at trocar sites and dripped onto the fallopian tubes. The nontreatment group served as controls. Visual analogue scales were used to evaluate pain and nausea (measured in millimeters). Demographic characteristics, postoperative requirements for analgesics and antiemetics, time to discharge, and unscheduled admission were also evaluated. During a 7-month period, 71 women were enrolled. Protocol subjects (N = 35) reported pain severity of 27.9 +/- 19.1 mm (mean +/- standard deviation), whereas controls (N = 36) reported 59.3 +/- 23.3 mm (P < .001). Fourteen protocol patients requested additional pain medication, compared with 29 controls (P < .001). Protocol patients indicated a nausea severity of 9.9 +/- 18.7 mm, whereas the controls reported 38.8 +/- 35.5 mm (P < .001). Only one protocol patient required nausea medication, compared with nine controls (P < .02). Severity of pain correlated with severity of nausea (r = 0.38166, P < .001). Protocol patients were discharged from the outpatient surgery unit in 148.6 +/- 45.0 minutes, compared with 176.4 +/- 58.5 minutes for controls (P < .03). This regimen reduced the severity of pain and nausea after outpatient laparoscopic sterilization. The need for additional analgesics and antiemetics was also reduced. Protocol patients were discharged earlier than controls. These benefits seem to accrue without significant risk. We believe that this regimen may also be useful in other ambulatory laparoscopic procedures.

Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy

The efficacy of ketorolac, a non-steroidal anti-inflammatory drug, in the management of moderate to severe pain in adults, has led us to conduct a trial of this analgesic in children following tonsillectomy. Children were randomized to receive intramuscular (i.m.) ketorolac (1 mg/kg, EXP group, n = 45) or saline (CTL group, n = 42) at the completion of surgery. Intravenous (i.v.) fentanyl (0.5 μg/kg/dose) was administered in repeated doses postoperatively. Pain intensity was measured using both the Oucher and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) to allow for comparison between self-report and behavioral measures of pain intensity. Severity of postoperative bleeding was measured using a 4-point rating scale. The EXP group had a significant reduction in total fentanyl dose (mean: 35.9 μg) compared to the CTL group (mean: 48.3 μg, t = −2.21, P < 0.03). There was a statistically significant decrease in pre-fentanyl CHEOPS scores in the Post-Anesthesia Care Unit (PACU) in the ketorolac group ( F (2,30) = 5.34, P < 0.01), but not in the saline group ( F (2.24) = 2.46, P > 0.05). In the first hour postoperatively, the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids, in both groups. In the PACU, children were unable to provide a self-report of pain intensity potentially due to a variety of factors (e.g., emergence delirium, agitation, excitement, sedation, and/or pain). However, during the remainder of the postoperative stay, the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS. There were no differences between the 2 groups in the severity of postoperative bleeding. Children in the EXP group were discharged significantly earlier (i.e., 30 min, t = −2.22, P < 0.03). Our data demonstrate that i.m. administration of ketorolac, at the end of surgery, significantly reduces opioid requirements and shortens length of stay without any evidence of increased bleeding. In addition, our data suggest that the patient's altered level of consciousness and attention span may diminish the utility of self-report measures of pain intensity in the immediate postoperative period.

The Efficacy of intramuscular ketorolac in combination with intravenous PCA morphine for postoperative pain relief

The Efficacy of intramuscular ketorolac in combination with intravenous PCA morphine for postoperative pain relief

IM KETOROLAC VS. ORAL IBUPROFEN IN THE EMERGENCY DEPARTMENT.

Ketorolac is the only nonsteroidal antiinflammatory drug (NSAID) available for parenteral use. This study examined the relative effectiveness of intramuscular (IM) ketorolac and oral ibuprofen for 77 emergency department patients with mild-to-moderate …

A comparison of intramuscular ketorolac and pethidine in the alleviation of renal colic

To compare the analgesic efficacy of a single 30 mg intramuscular dose of ketorolac with that of intramuscular pethidine 100 mg, in a double-blind, parallel-group investigation of patients presenting with pain suggestive of renal colic. Seventy-six patients (17 women, 15 men; mean age 45.2 years, range 20-80) were allocated by means of a pre-determined randomization schedule to receive ketorolac and 78 patients (20 women, 58 men; mean age 42.1, years range 18-70) to receive pethidine. Data from eight patients in the ketorolac group and six in the pethidine group were excluded from the efficacy analyses because of protocol violations. The severity of each patient's pain was assessed on a four-point verbal rating scale (VRS) and a 10 cm visual analogue scale at pre-dose and at 15 min intervals for the first hour post dosing. The time to first administration of rescue analgesic, up to 24 h following dosing with the study medication, was recorded. Adverse events were elicited by general questioning. Eighty-eight per cent of patients in each treatment group had improved according to the VRS of pain severity 1 h after dosing; the summed pain intensity differences up to 1 h were statistically significantly different in favour of ketorolac (P < 0.05). Fifty-six per cent of patients who were receiving ketorolac required rescue analgesia during the study period compared with 74% receiving pethidine. The incidences of adverse events were lower in the ketorolac group (28%) than the pethidine group (51%). Ketorolac can be considered a viable alternative to pethidine for the treatment of renal colic.

Effect of intraoperative ketorolac on postanesthesia care unit comfort

The efficacy of intraoperatively administered ketorolac for the prophylactic treatment of pain in the postanesthesia care unit (PACU) was examined in a prospective, double-blinded study. Thirty patients undergoing general anesthesia for orthopedic or lower abdominal surgery were randomized into two groups. Both groups received equivalent doses of opioids intraoperatively. Upon surgical closure, one group received intramuscular (IM) ketorolac 60 mg (2 mL) and the other group received normal saline 2 mL, IM. The saline control group more frequently required opioid-analgesic supplementation in the PACU than did the ketorolac group ( P < 0.05). Time to first-required opioid dose in the PACU was 22 ± 8 versus 76 ± 11 min for the control group and ketorolac group, respectively ( P < 0.001). The ketorolac group reported significantly lower pain scores 1 hr after PACU admission ( P < 0.01). Time to PACU discharge was not different between groups. Intraoperatively administered ketorolac is an effective adjunct in the management of postoperative pain.

Intramuscular Ketorolac for Postoperative Analgesia following Laparoscopic Sterilisation

The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended.

Ketorolac and Patient Controlled Analgesia in the Treatment of Postoperative Pain

Ketorolac tromethamine (Toradol [Syntex, Palo Alto]), a new commercially available nonsteroidal antiinflammatory drug (NSAID), has appropriate solubility and minimal tissue irritation, making it suitable for intramuscular injection. Previously, NSAID have only been available for oral use in the United States for the treatment of pain. Ketorolac, the most potent NSAID known, relieves pain through inhibition of arachidonic acid synthesis at the cyclooxygenase level and has no central opioid effects. The results of previous studies using parenteral ketorolac in combination with patient administered narcotics have shown a 40 percent reduction in narcotic requirements. However, ketorolac is presently only approved for intramuscular injection and oral use in the United States. In a prospective, randomized study, we compared intramuscular ketorolac in combination with patient controlled intravenous narcotic analgesia (morphine) (PCA-M) to PCA-M alone for the control of pain after extensive colonic resections. The combination of intramuscular ketorolac and PCA-M provided equal pain relief with no increased side effects when compared with narcotics alone. However, narcotic requirements of the patients were decreased by an average of 45 percent. Ketorolac and narcotics in combination provide effective postoperative pain relief and significantly decrease narcotic requirements. This combination may be particularly beneficial in the subpopulation of patients especially prone to narcotic related complications.