Comparative Analgesic Efficacy of Patient-Controlled Analgesia with Ketorolac Versus Morphine After Elective Intraabdominal Operations

Abstract

We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. Group 1 (n = 25) received up to two intravenous (IV) boluses of 5 mg of morphine followed by IV morphine PCA, whereas those in Group 2 (n = 26) received up to two IV boluses of 30 mg ketorolac, then IV ketorolac PCA. Up to two rescue doses of morphine (5 mg per dose, subcutaneously) were given in either group when pain during deep inhalation exceeded 5/10 on VAS. Ten patients from Group 1 required rescue doses of morphine compared to 22 patients from Group 2 (P < 0.0011). Two and 16 patients from Groups 1 and 2, respectively, were withdrawn because of inadequate analgesia (P < 0.01). Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.

Comparison of the Effectiveness of Unimodal Opioid Analgesia with Multimodal Analgesia in the Management of Postoperative Pain in Patients Undergoing Surgery under Spinal Anesthesia-Double Blind Study

“…They found that Ketorolac was more effective than morphine. These results contrast with clinical experience and consensus recommendations that opioids are more effective than NSAIDs for moderate-to-severe acute pain [19,20].…”

Clinical trial: alvimopan for the management of post‐operative ileus after abdominal surgery: results of an international randomized, double‐blind, multicentre, placebo‐controlled clinical study

“…nasogastric intubation, early enteral feeding and early mobilization) as well as pharmacological (mainly the use of prokinetic agents or laxatives) strategies. However, none of the current management approaches, used individually, has consistently been effective in accelerating the resolution of POI, 29–38 while maintaining adequate pain relief. New effective treatments for POI are needed.…”

Efficacy and Safety of Steroid Use for Postoperative Pain Relief

“…They decrease the opioid requirement and enhance the quality of analgesia produced by opioid medications 37 . However, it has been shown that, when used alone, they are not powerful enough to manage severe pain in most patients 38 . Indomethacin, tenoxicam, ketorolac, diclofenac, and ibuprofen have been found to be useful analgesic drugs after surgery.…”