Ketorolac or fentanyl to supplement local anesthesia?
OBJECTIVE
To evaluate the usefulness of ketorolac in the treatment of intraoperative pain refractory to the administration of local anesthetic alone.


METHODS
Intraoperative acute-pain treatment model consisting of awake, nonsedated patients who randomly received either an opioid or a study drug in a double-blind fashion.


METHODS
University medical center.


METHODS
Eighty patients who underwent breast biopsy, lumpectomy, or central venous catheter placement.


METHODS
Patients received either ketorolac 1 mg/kg intravenously (IV) up to a total dose of 60 mg or fentanyl 3 micrograms/kg IV up to a total dose of 250 micrograms to supplement the local anesthetic.


RESULTS
Verbal pain evaluation and the visual analog scale (VAS) were used for perioperative measurement of pain. Heart rate (HR), blood pressure, and respiratory rate (RR) were recorded before and after analgesic drug injections at 10-minute intervals, both intraoperatively and while the patient was in the postanesthesia care unit (PACU). Speed of recovery was quantified by p-deletion and digit substitution tests on admission to the PACU and at 30-minute intervals until discharge. The frequency of nausea, vomiting, and pruritus were recorded. There were no differences between the groups in perioperative verbal pain evaluation, VAS scores, HR, systolic blood pressure, diastolic blood pressure, or RR. Patients who received ketorolac exhibited a significantly lower frequency of intraoperative and postoperative medication administration intraoperatively, than those who received fentanyl. No additional pain medication was required by patients in the PACU in either group.


CONCLUSIONS
Ketorolac is a useful alternative to fentanyl for the treatment of intraoperative pain refractory to the administration of local anesthetic alone during monitored anesthesia care. A decided advantage of ketorolac over fentanyl is the absence of nausea and vomiting in the intraoperative and postoperative periods.
Bosek
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Department of Anesthesiology, University of South Florida College of Medicine, Tampa 33612-4799.
Smith
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DB
Cox
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D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D000772:Anesthesia, Local; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D020910:Ketorolac; D008297:Male; D008875:Middle Aged; D012119:Respiration / Q000187:drug effects / Q000502:physiology; D014046:Tolmetin / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000700:Analgesics; D014046:Tolmetin; D005283:Fentanyl; D020910:Ketorolac