title: Analgesic and antiemetic effect of ketorolac vs. betamethasone or dexamethasone after ambulatory surgery.
abstract: BACKGROUND
  Glucocorticoids are known to provide slower onset and more prolonged duration of analgesic effect than ketorolac. In the present study, we wanted to evaluate the effect over time from a single dose of either intravenous (i.v.) dexamethasone or an intramuscular (i.m.) depot formulation of betamethasone compared with i.v. ketorolac.
  
  
  METHODS
  One hundred and seventy-nine patients admitted for mixed ambulatory surgery were included in the study. After induction of general i.v. anaesthesia, the patients were randomized to receive double-blindly either dexamethasone 4 mg i.v. (Group D) or betamethasone depot formulation 12 mg i.m. (Group B) or ketorolac 30 mg i.v. (Group K). Fentanyl was used for rescue analgesic medication in the post-operative care unit (PACU) and codeine with paracetamol after discharge, for a study period of 3 days.
  
  
  RESULTS
  There was significantly less post-operative pain in the ketorolac group during the stay in the unit (88% with minor or less pain in Group K vs. 74% and 67% in Groups D and B, respectively, P < 0.05), significantly less need for rescue medication (P < 0.05) and significantly less nausea or vomiting (12% in Group K vs. 30% in the other groups pooled, P < 0.05). The ketorolac patients were significantly faster for ready discharge, median 165 min vs. 192 min and 203 min in Groups D and B, respectively (P < 0.01). There were no differences between the groups in perceived pain, nausea, vomiting or rescue analgesic consumption in the 4- to 72-h period.
  
  
  CONCLUSIONS
  Dexamethasone 4 mg or bethamethasone 12 mg did not provide prolonged post-operative analgesic effect compared with ketorolac 30 mg, which was superior for analgesia and antiemesis in the PACU.
authors.affiliation: Department of Anaesthesiology, University of Oslo, Faculty Division, Ullevaal University Hospital, Oslo, Norway.
authors.forename: K S
authors.initials: KS
authors.lastname: Thagaard
authors.forename: H H
authors.initials: HH
authors.lastname: Jensen
authors.forename: J
authors.initials: J
authors.lastname: Raeder
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage; D003692:Delayed-Action Preparations; D003907:Dexamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000932:Antiemetics; D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone; D020910:Ketorolac