title: Effect of endovenous morphine vs. ketorolac on proinflammatory cytokines during postoperative analgesia in laparoscopic cholecystectomy.
abstract: BACKGROUND
  Postoperative pain is the main symptom following a surgical event and is related to an inflammatory process involving cytokine secretion. This type of pain is usually treated with opioids such as morphine, whose analgesic efficacy is well known. However, it is unknown when compared with ketorolac in measuring proinflammatory cytokine levels. The aim of this study was to determine the postoperative analgesic effect with endovenous morphine on proinflammatory cytokine levels in patients who underwent laparoscopic choleystectomy.
  
  
  METHODS
  We studied 40 patients who underwent laparoscopic cholecystectomy. Patients were randomized to receive morphine (0.05 mg/kg) or ketorolac (0.2 mg/kg) IV during gallbladder extraction and after the surgical event at the following dose: morphine (0.15 mg/kg) or ketorolac (0.7 mg/kg) for 40 min. Clinical evaluations included were hemodynamic, analgesic with visual analogue scale, and sedation (Ramsay scale). IL-1β and TNF-a were measured pre- and postoperatively and after 12 h. Safety profile was evaluated with hemodynamic constants. Statistical analysis was carried out using Mann-Whitney U test and Fisher exact test.
  
  
  RESULTS
  TNF-a was increased significantly in the immediate postoperative period and after 12 h in the morphine group. IL-1β was not detected preoperatively, in the immediate postoperative period and 12 h after surgery the levels were similar in both groups. The main adverse event was respiratory depression, which occurred in the morphine group.
  
  
  CONCLUSIONS
  Proinflammatory cytokines were increased after surgery, particularly TNF-a in the group receiving morphine. The use of morphine is safe postoperatively.
authors.affiliation: Departamento de Anestesiología, Hospital General de Zona No. 89, IMSS Guadalajara, Jalisco, México.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Gómez-Vázquez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hernández-Salazar
authors.forename: Jorge Daniel
authors.initials: JD
authors.lastname: Novelo-Otañez
authors.forename: Carlos Enrique
authors.initials: CE
authors.lastname: Cabrera-Pivaral
authors.forename: Ingrid Patricia
authors.initials: IP
authors.lastname: Dávalos-Rodríguez
authors.forename: Mario
authors.initials: M
authors.lastname: Salazar-Páramo
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007262:Infusions, Intravenous; D053583:Interleukin-1beta / Q000097:blood* / Q000378:metabolism; D020910:Ketorolac / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D019106:Postoperative Hemorrhage / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012131:Respiratory Insufficiency / Q000139:chemically induced; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis* / Q000378:metabolism; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D053583:Interleukin-1beta; D009294:Narcotics; D014409:Tumor Necrosis Factor-alpha; D009020:Morphine; D020910:Ketorolac