title: Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial.
abstract: OBJECTIVE
  Ketorolac is a parenterally active nonsteroidal anti-inflammatory drug with localized anti-inflammatory properties. We examine the postoperative analgesic efficacy of locally administered intraperitoneal (IP) ketorolac compared with intravenous (IV) ketorolac during laparoscopic cholecystectomy.
  
  
  METHODS
  With institutional ethics approval, 120 patients undergoing elective laparoscopic cholecystectomy were randomized to receive intraoperative 1) IP ketorolac 30 mg + intravenous saline (IP group), 2) intraperitoneal saline + IV ketorolac 30 mg (IV group), or 3) intraperitoneal saline + intravenous saline (Control group) under standardized anesthesia. The primary and secondary outcomes were postoperative fentanyl requirements in the postanesthesia care unit and the time to first analgesic request, respectively. Other outcomes examined included abdominal pain (at rest and with coughing), shoulder pain, nausea, vomiting, and any other postoperative complications.
  
  
  RESULTS
  On average, patients receiving IP ketorolac required less (mean difference, 29 μg; 95% confidence interval [CI], 2 to 56; P = 0.04) fentanyl than patients in the Control group but a similar (mean difference, 16 μg; 95% CI, 12 to 43; P = 0.27) amount compared to patients in the IV group. There was an increase in the median (interquartile range [IQR]) time to first request in the IP group (43[30-52] min) compared with the Control group (35 [27-49]min; P = 0.04) but no difference between the IP group compared with the IV group (47 [40-75] min; P = 0.22). Shoulder pain and resting pain were reduced with IP and IV ketorolac compared with Control, but there was no difference between the IP and IV groups. No differences were observed in any other outcomes, side effects, or complications attributable to opioids or ketorolac at any time points.
  
  
  CONCLUSIONS
  This study did not demonstrate any advantage for the off-label topical intraperitoneal administration of ketorolac in this surgical population. Intraperitoneal and IV ketorolac showed comparable analgesic efficacy following laparoscopic cholecystectomy.
authors: Department of Anesthesiology & Perioperative Medicine, Victory 2, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, Canada, K7L 2V7. murdochj@kgh.kari.net.
authors: John
authors: J
authors: Murdoch
authors: Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors: Gillian
authors: G
authors: Ramsey
authors: Kingston General Hospital Research Institute, Kingston General Hospital, Kingston, ON, Canada.
authors: Andrew G
authors: AG
authors: Day
authors: Department of Anesthesiology & Perioperative Medicine, Victory 2, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, Canada, K7L 2V7.
authors: Michael
authors: M
authors: McMullen
authors: Department of Anesthesiology & Perioperative Medicine, Victory 2, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, Canada, K7L 2V7.
authors: Elizabeth
authors: E
authors: Orr
authors: Department of Anesthesiology & Perioperative Medicine, Victory 2, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, ON, Canada, K7L 2V7.
authors: Rachel
authors: R
authors: Phelan
authors: Department of Surgery, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors: Diederick
authors: D
authors: Jalink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac