The effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response.
We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2 mg/h). The control group (n = 47) received an IM bolus of NaCl 0.9% (1 mL) followed by continuous saline infusion (2 mL/h) for 24 h. Operative blood losses, postoperative pain, sedation, and on-demand morphine consumption (patient-controlled analgesia [PCA]) were measured. The effects on plasma catecholamines, cortisol, potassium, creatinine, skin bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT) were also evaluated. Ketorolac improved pain scores (P < 0.05) and reduced plasma cortisol concentrations between 2 and 6 h (P < 0.05). No significant differences were observed concerning operative blood losses, glucose concentration, and renal and hemostatic functions. The ketorolac group required less morphine (not significant [NS]) than the control group and had less adverse effects (P = 0.002). Thus, perioperative ketorolac infusion improved the quality of postoperative pain relief, and had no major influence on endocrine-metabolic response and no negative influences on hemostatic and renal functions. This study suggests that preventive ketorolac administration, followed by a continuous infusion, is an easy, useful, and safe method for pain control after abdominal surgery.
Varrassi
G
G
Department of Anesthesia, Intensive Care and Pain Treatment, L'Aquila University, Italy.
Panella
L
L
Piroli
A
A
Marinangeli
F
F
Varrassi
S
S
Wolman
I
I
Niv
D
D
D000700:Analgesics / Q000008:administration & dosage*; D001786:Blood Glucose / Q000378:metabolism; D002763:Cholecystectomy; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007262:Infusions, Intravenous; D020910:Ketorolac; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000453:epidemiology; D011188:Potassium / Q000097:blood; D011517:Prothrombin Time; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000700:Analgesics; D001786:Blood Glucose; D003404:Creatinine; D014046:Tolmetin; D011188:Potassium; D006854:Hydrocortisone; D020910:Ketorolac