Ketorolac: safe and effective analgesia for the management of renal cortical tumors with partial nephrectomy.
OBJECTIVE
Ketorolac has demonstrated advantages as a supplement to opioid based analgesia in several surgical settings, including donor nephrectomy. To our knowledge there has been no published data to date on the use of ketorolac in patients undergoing partial nephrectomy. We compared analgesia with ketorolac and opioids to analgesia with opioids alone with regard to pain control, postoperative recovery and effects on renal function in patients with renal cortical tumors surgically managed by partial nephrectomy.


METHODS
Records for 154 patients treated with partial nephrectomy for renal cortical tumors were retrospectively analyzed. Clinicopathological variables examined were age, gender, medication use, comorbidity profile, operation side, estimated blood loss, hospital stay, operative duration, American Society of Anesthesiologists class, histopathology results, perioperative transfusion status, ischemia type (warm vs cold vs none), duration of renal artery cross clamping, tumor size and intraparenchymal location, pathological stage and perioperative complications. Postoperative duration to the initiation of solid diet, discontinuation of patient controlled analgesia and overall pain control were assessed. Serum creatinine was measured during the preoperative period, and at 1, 3 or greater and 30 or greater days postoperatively.


RESULTS
Patients who received ketorolac demonstrated superior postoperative recovery with an earlier return to solid diet and earlier discontinuation of patient controlled analgesia. Treatment groups were similar with respect to changes in serum creatinine, blood loss, transfusion rates and complication rates. Ketorolac was not associated with an increased risk of acute renal failure.


CONCLUSIONS
Ketorolac is a safe and effective supplement to opioid based analgesia for pain control after partial nephrectomy.
Diblasio
Christopher J
CJ
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Snyder
Mark E
ME
Kattan
Michael W
MW
Russo
Paul
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D020911:Ketorolac Tromethamine / Q000627:therapeutic use*; D007672:Kidney Cortex; D007680:Kidney Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine