Intraoperative hetorolac
has an opioid-sparing effect in women after diagnostic laparoscopy but not
after laparoscopic tubal ligation. Green CR, Pandit SK, Levy L, et al; Anesth Analg.
[ see abstract below ]
Ketorolac is used extensively to provide postoperative analgesia.
This study investigates whether intraoperative ketorolac with fentanyl would
decrease postoperative analgesic requirements, and evaluates the effect
of surgical procedure on these requirements.
ABSTRACT
Ketorolac tromethamine (Toradol h) is a parenteral, nonsteroidal antiinflammatory drug that is being extensively used to provide postoperative analgesia. This study evaluated whether intraoperative ketorolac would act synergistically with fentanyl to decrease postoperative analgesic requirements in outpatients undergoing gynecologic procedures.
The patients studied were adult ASA physical status I or 11 females scheduled for diagnostic laparoscopy (DL) (n = 80) or laparoscopic tubal ligation (TL) (n = 46). Each patient received fentanyl 2 ug/kg intravenously (IV) before induction, followed by a standardized propofol anesthetic and 2 mL of saline or ketorolac 60 mg IV in a randomized double-blind fashion 30 min before the anticipated end of the operative procedure.
Patients were assessed for postoperative pain via a 10-cm visual analog scale (VAS) (O = no pain; 10 = severe pain) before analgesic treatment in the postanesthesia care unit (PACU).
Severe postoperative pain (VAS of 5 or more) was treated with incremental doses of fentanyl, 25-50 ug IV by a blinded PACU nurse. Ibuprofen or acetaminophen with codeine was administered for pain control once the patient tolerated oral medications. This study showed that intraoperative ketorolac (60 mg IV) with fentanyl (2 ug/kg IV) administered at the induction of anesthesia resulted in significant opioid sparing and a diminution in pain in the DL sample but not in the TL sample.
The analgesic regimen was also associated with a lower incidence of nausea and vomiting and resulted in earlier discharge, which was not seen after TL. These results demonstrate that pain after TL is far greater than that after DL, which suggests that these procedures should be considered separately when designing analgesic regimens.
This study was supported in part by Roche Pharmaceuticals.
Accepted for publication Accepted for publication November 22, 1995.
Address correspondence and reprint requests to Carmen R.
Green, MD, Department of Anesthesiology, University of Michigan Medical Center, IG323 University Hospital, Box 0048, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0048.
