Intravenous ketorolac as an adjunct to patient-controlled analgesia (PCA) for management of postgynecologic surgical pain.
OBJECTIVE
To determine whether intravenous (IV) doses of ketorolac tromethamine provide safe and effective augmentation of postsurgical analgesia for patients using IV patient-controlled analgesia (PCA) with morphine.


METHODS
Randomized, double-blind, placebo-controlled, dose-response evaluation.


METHODS
Patient care unit at a university medical center.


METHODS
62 ASA physical status I-III females recovering from intra-abdominal gynecologic surgery with general anesthesia who requested postoperative PCA.


METHODS
Following initial pain assessment in the recovery room, patients were randomized to receive either IV saline (placebo) followed by IV saline every 6 hours (Group 1); IV ketorolac 30 mg loading dose followed by IV ketorolac 15 mg every 6 hours (Group 2); or IV ketorolac 60 mg loading dose followed by IV ketorolac 30 mg every 6 hours (Group 3). All patients were provided IV PCA, which was programmed to provide 1.2 mg of morphine with a 6-minute lockout interval.


RESULTS
Visual analog scale (VAS) resting pain and satisfaction scores were measured every 2 to 12 hours. Cumulative PCA with morphine and the frequency and severity of side effects also were assessed. IV ketorolac showed no clinically significant side effects. Group 2 patients experienced significant reductions in VAS resting pain scores (p < 0.05), and a trend toward decreased morphine self-administration in both active groups was noted. Group 2 and Group 3 patients reported greater satisfaction with postsurgical analgesia than Group 1 patients. (p < 0.05).


CONCLUSIONS
IV ketorolac used as an analgesic adjunct provided safe and effective augmentation of PCA with morphine in patients recovering from intra-abdominal gynecologic surgery.
Sevarino
F B
FB
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
Sinatra
R S
RS
Paige
D
D
Silverman
D G
DG
D000328:Adult; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007275:Injections, Intravenous; D020911:Ketorolac Tromethamine; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014325:Tromethamine / Q000008:administration & dosage*
D000700:Analgesics; D004338:Drug Combinations; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D009020:Morphine; D014046:Tolmetin