title: [Ketorolac for prevention of acute postoperative pain].
abstract: BACKGROUND
  Since NSAIDs are competitive antagonists of cyclooxygenase, they prevent the biosynthesis of prostaglandins, responsible for enhanced nociceptive sensitization and primary hyperalgesia. If NSAIDs administration is performed after eicosanoids cascade activation by surgical trauma, already released prostaglandins can exert their hyperalgesic effects for a finite time. Therefore prophylactic administration of NSAIDs (pre-emptive analgesia) should improve their effectiveness on acute postoperative pain.
  
  
  OBJECTIVE
  To assess the analgesic effect of preoperatively administered ketorolac, compared with its administration after surgical trauma.
  
  
  METHODS
  Thirty adult patients, ASA physical status I-II, undergoing elective septoplasty, were allocated randomly in two groups, depending on timing of i.v. administration of ketorolac 0.4 mg/kg: 10 min before induction (group I); or 5 min after décollement of nasal septum cartilaginoid plan (group II). No other analgesic drugs were given. Postoperative pain was assessed with objective (SAP, DAP, HR) and subjective (VAS, BS 11) methods at 60, 90, 120, 150, and 180 min after the end of surgery. Rate and severity of any side-effect were recorded.
  
  
  RESULTS
  Both VAS and BS 11 showed significant better pain relief after preoperative ketorolac at all time, without any adverse effect. Same result was shown by SAP at 60 and 90 min postoperatively.
  
  
  CONCLUSIONS
  Due to prevention of nociceptive sensitization of prostaglandins released by tissue trauma, prophylactic NSAIDs administration to surgical patients with mild to moderate postoperative pain can improve their antinociceptive effects.
authors.affiliation: Istituto di Anestesiologia e Rianimazione, Università degli Studi, Cagliari.
authors.forename: V A
authors.initials: VA
authors.lastname: Peduto
authors.forename: A
authors.initials: A
authors.lastname: Toscano
authors.forename: R
authors.initials: R
authors.lastname: D'Uva
authors.forename: M
authors.initials: M
authors.lastname: Piga
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020910:Ketorolac; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control*; D014046:Tolmetin / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D018712:Analgesics, Non-Narcotic; D014046:Tolmetin; D020910:Ketorolac