title: The safety and efficacy of intravenous ketorolac in patients undergoing primary endoscopic sinus surgery: a randomized, double-blinded clinical trial.
abstract: BACKGROUND
  Ketorolac (KT) is an intravenous (IV) nonsteroidal anti-inflammatory drug (NSAID) for acute, moderate pain. KT is safe, but may be linked to increased risk of post-tonsillectomy hemorrhage. The safety and efficacy of KT following primary endoscopic sinus surgery (ESS) is unknown.
  
  
  METHODS
  All patients underwent primary ESS and septoplasty. Patients randomly received either IVKT 30 mg or IV fentanyl (IVF) 25 μg postprocedure. Postoperative pain was recorded at 0, 30, and 60 minutes via visual analog scale (VAS), and patients received as needed fentanyl and hydrocodone/acetaminophen for additional pain. Postoperative bleeding questionnaires were completed on postoperative days 1 and 7 (POD 1 and POD 7). Preoperative and POD 7 hemoglobin was assessed.
  
  
  RESULTS
  A total of 34 patients enrolled in the study over 1 year. Sixteen patients received IVKT and 18 patients received IVF. The average time of administration was 23 ± 6 minutes postprocedure. There were no significant differences in preoperative and postoperative hemoglobin levels between groups and bleeding assessments. There were no incidences of postoperative hemorrhage. There was no significant difference in pain VAS between the IVKT and IVF groups (3.5, 3.2, 2.1 vs 3.0, 4.4, 3.8 at 0, 30, and 60 minutes, respectively). There was no significant difference between the number of doses of supplemental analgesics for the IVKT and IVF groups (2.0 vs 3.4 doses IV; 1.0 vs 1.4 doses orally, respectively).
  
  
  CONCLUSIONS
  In this study, IVKT was a safe analgesic in the setting of primary ESS. There was no increased risk of hemorrhage or acute blood-loss anemia. IVKT did not appear to offer statistically significant pain control over IVF.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Loyola University, Maywood, IL, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Moeller
authors.forename: Julius
authors.initials: J
authors.lastname: Pawlowski
authors.forename: Ana L
authors.initials: AL
authors.lastname: Pappas
authors.forename: Keith
authors.initials: K
authors.lastname: Fargo
authors.forename: Kevin
authors.initials: K
authors.lastname: Welch
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control; D010256:Paranasal Sinuses / Q000187:drug effects / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D012220:Rhinitis / Q000188:drug therapy* / Q000601:surgery; D012306:Risk; D012852:Sinusitis / Q000188:drug therapy* / Q000601:surgery; D014068:Tonsillectomy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006454:Hemoglobins; D005283:Fentanyl; D020910:Ketorolac