Postoperative intravenous patient-controlled analgesia in thyroid surgery: comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs), through synergistic action with opioids, can reduce postoperative nausea and vomiting via intravenous patient-controlled analgesia (PCA). We compared the efficacy of three PCA regimens.


METHODS
Patients (n = 135) undergoing thyroidectomy were randomly allocated to three PCA regimens. All groups received 12 mg ondansetron (a serotonin 5-HT(3) receptor antagonist). In addition, Group I received the opioid fentanyl, 15 microg/kg. Group II received fentanyl 12.5 microg/kg and the NSAID ketorolac, 1.5 mg/kg, and Group III received fentanyl 10 microg/kg and ketorolac 3 mg/kg. Pain scores, nausea and vomiting, and dizziness were assessed 1, 6, 12, and 24 hours postoperatively.


RESULTS
Pain scores were similar among the three groups. However, postoperative nausea and vomiting was significantly lower in groups II and III (p < 0.05) than group I. Postoperative dizziness was significantly lower in group III than groups I and II (p < 0.05).


CONCLUSIONS
The NSAID ketorolac when combined with lower doses of the opioid fentanyl and the same dose of ondansetron is associated with the same analgesic efficacy but less nausea and vomiting after thyroid surgery. A higher ratio of NSAID to opioid, when used as reported here, is associated with less postoperative dizziness.
Kim
So Yeon
SY
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Seoul, Korea.
Kim
Eun Mi
EM
Nam
Kee-Hyun
KH
Chang
Dong Jin
DJ
Nam
Sun Ho
SH
Kim
Ki Jun
KJ
D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004244:Dizziness / Q000188:drug therapy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D013965:Thyroidectomy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D017294:Ondansetron; D005283:Fentanyl; D020910:Ketorolac