title: Intraoperative ketorolac has an opioid-sparing effect in women after diagnostic laparoscopy but not after laparoscopic tubal ligation.
abstract: Ketorolac tromethamine (Toradol) 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 II females scheduled for diagnostic laparoscopy (DL) (n = 80) or laparoscopic tubal ligation (TL) (n = 46). Each patient received fentanyl 2 micrograms/kg intravenously (i.v.) before induction, followed by a standardized propofol anesthetic and 2 mL of saline or ketorolac 60 mg i.v. 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) (0 = no pain; 10 = severe pain) before analgesic treatment in the postanesthesia care unit (PACU). Severe postoperative pain (VAS or 5 or more) was treated with incremental doses of fentanyl, 25-50 micrograms i.v. 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 i.v.) with fentanyl (2 micrograms/kg i.v.) 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.
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor 48109-0048, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Green
authors.forename: S K
authors.initials: SK
authors.lastname: Pandit
authors.forename: L
authors.initials: L
authors.lastname: Levy
authors.forename: S P
authors.initials: SP
authors.lastname: Kothary
authors.forename: A R
authors.initials: AR
authors.lastname: Tait
authors.forename: M A
authors.initials: MA
authors.lastname: Schork
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010045:Outpatients; D010146:Pain / Q000517:prevention & control; D010351:Patient Discharge; D011446:Prospective Studies; D013246:Sterilization, Tubal / Q000379:methods*; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014325:Tromethamine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014839:Vomiting
chemical_list: D018712:Analgesics, Non-Narcotic; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D014046:Tolmetin