Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery

• Published in: Journal of clinical anesthesia Vol. 7; no. 2; pp. 103 - 108
• Main Authors: Blackburn, Amanda, Stevens, Jeremy D., Wheatley, Robert G., Madej, Tamara H., Hunter, Deborah
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.1995
• Subjects: Adolescent; Adult; Aged; Analgesia, Patient-Controlled - adverse effects; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - adverse effects; Analgesics, Non-Narcotic - therapeutic use; Anesthesia; Double-Blind Method; Female; Humans; Hypoxemia; Hypoxia - blood; Hysterectomy; Injections, Intravenous; Ketorolac; Middle Aged; morphine; Morphine - administration & dosage; Morphine - adverse effects; Morphine - therapeutic use; Pain Measurement; pain, postoperative; Pain, Postoperative - drug therapy; patient-controlled analgesia; Postoperative Complications - blood; Tolmetin - administration & dosage; Tolmetin - adverse effects; Tolmetin - analogs & derivatives; Tolmetin - therapeutic use; Hypoxemia; ketorolac; patient-controlled analgesia; morphine; pain, postoperative
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/0952-8180(94)00040-B

Study Objective: To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (IV) infusion of ketorolac following lower abdominal surgery. Design: Randomized, double-blind, placebo-controlled, parallel-group study. Setting: Inpatient elective gynecologic surgical patients. Patients: 60 ASA physical status I or II patients aged 18 to 70 years scheduled for elective abdominal hysterectomy. Interventions: Following standardized preparation and anesthesia, continuous IV infusions of either ketorolac or placebo were administered for 24 hours postoperatively with a patients' standardized postoperative protocol. Supplementary analgesia was administered by an IV patient-controlled analgesia (PCA) system. Measurements and Main Results: A significantly lower proportion of the patients in the ketorolac group (6%) rated their pain at 24 hours as moderate or severe compared with patients in the placebo group (34%) ( p = 0.04). Mean 24-hour morphine consumption was significantly lower in the ketorolac group (43 mg; SEM 5 mg) compared with the placebo group (55 mg SEM 5 mg) ( p = 0.02). There was no significant difference in the incidence of postoperative hypoxemia between the groups with respect to mean times per hour spent with oxygen saturation (SpO 2) less than 85%, more than 85% but less than 90%, or more than 90% but less than 94%, mean hourly SpO 2, or the incidence and duration of severe hypoxemic episodes. Nausea and vomiting were the only significant adverse events, and they occurred in 30% of patients in both groups. Conclusion: Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.