Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study.
OBJECTIVE
Postoperative ileus (PI) is one of many common complications in major abdominal surgery. PI results in patient discomfort, increased gastrointestinal leakage, prolonged hospital stay, and increased medical expenses. In this study, we have investigated the morphine-sparing effects of ketorolac and its correlation with the duration of PI in patients with colorectal surgeries.


METHODS
We collected data from 102 patients who had received elective colorectal resection. The patients were randomly allocated into 2 groups and received intravenous patient-controlled analgesia (IVPCA) morphine (M group) or IVPCA morphine plus ketorolac (M+K group). Time-scale morphine consumption (per 12 h), recovery of bowel functions (the first bowel movement and passage of flatus), pain scores, and opioid-related side effects were then recorded.


RESULTS
Patients in the M+K group received 18.3% less morphine than those in the M group within 72 postoperative hours. The maximal opioid-sparing effects of ketorolac appeared in 12 to 24 postoperative hours. The onset of the first bowel movement and passage of flatus was significantly less in the M+K group than in the M group. The M group showed a 5.25 times greater risk of inducing PI, a result comparable with the M+K group in colorectal surgery patients.


CONCLUSIONS
The addition of ketorolac to IVPCA morphine has demonstrated a clear opioid-sparing effect and benefits in regards to the shortening of the duration of bowel immobility. We suggest that adding ketorolac to morphine IVPCA be included in the multimodal postoperative rehabilitation program for the early restoration of normal bowel function.
Chen
Jui-Yuan
JY
Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Ko
Tsung-Lin
TL
Wen
Yeong-Ray
YR
Wu
Shu-Ching
SC
Chou
Yenn-Hwei
YH
Yien
Hwey-Wen
HW
Kuo
Cheng-Deng
CD
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000494:pharmacology* / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use; D003107:Colorectal Surgery / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D013997:Time Factors
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac