Double-Blind Comparison of the Morphine Sparing Effect of Continuous and Intermittent I.M. Administration of Ketorolac

Abstract

The morphine sparing effect of ketorolac 10 mg administered 4-hourly by intermittent i.m. injection was compared with a continuous i.m. infusion in a double-blind, placebo-controlled trial in patients undergoing upper abdominal surgery. During the 48-h postoperative period, each patient was provided with a patientcontrolled analgesia (PCA) system which delivered bolus doses of morphine and administered the intermittent i.m. doses automatically via a computer controlled pump. In the first 24 h after surgery, there was a significant reduction in morphine demanded by both groups receiving ketorolac compared with placebo. Patients who received a continuous infusion of ketorolac after abdominal surgery required a median dose of morphine by PCA which was 49% less than controls. In the second 24 h and over the entire 48 h of the study, patients in the continuous group required significantly less morphine than those in the placebo group. The intermittent group used less than the placebo group, but this was not significant.

Opiate sparing effect of fixed combination of diclophenac and orphenadrine after unilateral total hip arthroplasty: A double-blind, randomized, placebo-controlled, multi-centre clinical trial

“…As pain intensities were equally low in both treatment groups our study results show a statistically significant morphine-sparing effect of approximately 30% compared to placebo. This effect is comparable or even superior to previous findings [4,[18][19][20], a phenomenon which might be at least partially attributed to the use of the fixed-dose combination of diclofenac and orphenadrine. Orphenadrine is a centrally acting analgesic which blocks the NMDA and the H1-receptor causing faster onset of action compared to diclofenac alone [21].…”

Enhancement of fentanyl antinociception by subeffective doses of nitroparacetamol (NCX-701) in acute nociception and in carrageenan-induced monoarthritis

“…This therapy has been used either to enhance the analgesic properties or to decrease the incidence of unwanted side-effects caused by non-steroidal anti-inflammatory drugs (NSAIDs), especially those related to gastro-intestinal (GI) and renal toxicity. Among the best studied is the combination of NSAIDs and opiates, frequently used in the treatment of postoperative pain, and in the treatment of cancer to decrease the required dosage of opiates, and thereby to reduce the incidence of adverse effects (Burns et al, 1991). This therapy seems to be effective in the treatment of postoperative pain and in pain due to spinal cord sensitization (Gillies et al, 1987;Laitinen and Nuutinen, 1992;Bosek and Miguel, 1994), that severely impoverishes the quality of life of many patients.…”

Controversies in the Perioperative Use of Nonsterodial Antiinflammatory Drugs

“…The apparent "ceiling" effect of nonsteroidal antiinflammatory drugs [reproduced with permission from OHara et a1 (60)l. period (i.e., aftei24 h)(84)(85)(86). E~~~ thoigh t i e use of a perioperative ketorolac infusion improved the qualit; of postoperative pain relief, it had no majo; influence on the endocrine or metabolic responses to surgery(83).…”