Evaluation of the safety and efficacy of ketorolac versus morphine by patient-controlled analgesia for postoperative pain.
OBJECTIVE
To compare ketorolac tromethamine with morphine for pain management after major abdominal surgery.


METHODS
Double-blind, randomized study.


METHODS
Hospital recovery room and postoperative surgical unit.


METHODS
One hundred ninety-one patients with at least moderate pain after major abdominal surgery.


METHODS
Patients received ketorolac by patient-controlled analgesia (PCA) bolus alone (Ket B), ketorolac by bolus plus infusion (Ket I), or morphine by PCA bolus (morphine), with injectable morphine available for supplementation.


RESULTS
Levels of sedation, pain intensity, pain relief, and adverse events were recorded at baseline, at 2, 4, and 6 hours, and at termination. Supplemental morphine was required by 71% of Ket B patients, 67% of Ket I patients, and 38% of morphine patients (p < or = 0.001 for Ket B vs morphine). Although patients receiving ketorolac required more supplemental morphine than the morphine group (6.0 mg Ket I, 6.2 mg Ket B, 4.0 mg morphine), there was a large morphine-sparing effect in both ketorolac groups (total morphine 6.0 mg Ket I, 6.2 mg Ket B, 33.3 mg morphine). Overall pain relief scores were similar for morphine and Ket I groups, and were lower for Ket B than for morphine (p = 0.002). There were no differences among groups in numbers of patients with adverse events.


CONCLUSIONS
Ketorolac may be effective when administered by PCA device, and has a clear morphine-sparing effect.
O'Hara
D A
DA
Department of Anesthesia, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Fanciullo
G
G
Hubbard
L
L
Maneatis
T
T
Seuffert
P
P
Bynum
L
L
Shefrin
A
A
D000005:Abdomen / Q000601:surgery; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing; D014046:Tolmetin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine; D009020:Morphine; D014046:Tolmetin