Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity.
BACKGROUND
Prompt recovery of protective airway reflexes, freedom from pain, ability to cooperate with respiratory physical therapy, early ambulation and discharge from the postanesthesia care unit (PACU), coupled with a stable intraoperative environment have been desired goals of anesthesia management of morbidly obese patients. We used ketorolac in lieu of narcotics toward this goal and present our subjective and objective data in this study.


METHODS
A total of 50 morbidly obese patients undergoing laparoscopic gastric bypass surgery were randomly assigned to 2 groups of 25 each. Group I received intravenous ketorolac perioperatively, which was continued 24 hours postoperatively. Group II received remifentanyl intraoperatively as a part of balanced anesthesia. Intraoperative hemodynamic stability was assessed based on blood pressure, pulse rate, and bispectral index score values. Postoperative pain intensity using a visual analogue scale, as well as the presence of nausea, vomiting, hypotension, or respiratory depression, were also recorded.


RESULTS
Postoperative side effects, including pain, nausea, and vomiting; requirements for analgesics and antiemetic medications in the PACU; and the time spent in the PACU varied significantly between the 2 groups. Continued administration of ketorolac during the first 24 hours postoperatively led to improved patient satisfaction and more enthusiastic participation in respiratory physical therapy.


CONCLUSIONS
Perioperative use of intravenous ketorolac up to 24 hours after laparoscopic gastric bypass surgery for morbid obesity helps provide a more stable intraoperative environment, earlier discharge from the PACU, and better outcome in this subset of patients.
Govindarajan
Ramasamy
R
Department of Anesthesiology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. ramasgovi@hotmail.com
Ghosh
Biswajit
B
Sathyamoorthy
Madhan Kumar
MK
Kodali
Nagendra Srinivas
NS
Raza
Ahmed
A
Aronsohn
Judith
J
Rajpal
Sanjeev
S
Ramaswamy
Chitra
C
Abadir
Adel
A
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010147:Pain Measurement; D010880:Piperidines / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D000077208:Remifentanil
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010880:Piperidines; D000077208:Remifentanil; D020910:Ketorolac