Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity

Govindarajan, Ramasamy; Ghosh, Bikash Chandra; Sathyamoorthy, Madhan Kumar; Kodali, Nagendra S; Raza, Ahmed; Aronsohn, Judith; Rajpal, Sanjeev; Ramaswamy, Chitra; Ar, Amos

doi:10.1016/j.soard.2005.08.013

Cited by 57 publications

(4 citation statements)

References 10 publications

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“…Lidocaine, dexmedetomidine, ketamine and magnesium, when used as part of opioid-free anaesthesia, may have better anti-inflammatory effects than classical opioid-based anaesthesia and may therefore be preferable [ 131 ]. In addition, appropriate use of nonsteroidal anti-inflammatory drugs (NSAIDs) reduces opioid consumption [ 132 , 133 ]. One limitation of most NSAIDs is that they are “low-ceiling” analgesics.…”

Section: Results: Evidence Base and Recommendationsmentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

et al. 2022

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Background This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol. Methods A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations. Results The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries. Conclusion A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

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Section: Results: Evidence Base and Recommendationsmentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

et al. 2022

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“…Recent data on the efficacy and safety of multimodal pain management strategies for WLS patients are consistent with this accepted approach of opioid-sparing postoperative analgesia in the general surgical patient population (50). The nonsteroidal, antiinflammatory, ketorolac, has been successfully used in a variety of dosing regimens to reduce the need for opioid analgesics in open and laparoscopic WLS (10)(11)(12). Local anesthetic port or wound infiltration for open surgery is part of an effective multimodal analgesic approach (11,12).…”

Section: Postoperative Pain Managementmentioning

confidence: 81%

“…Clinical evidence to refine dosing recommendations for several neuromuscular blocking agents in severely obese patients has emerged (4)(5)(6), and α-2 agonists, a well-known drug class, are being applied in innovative contexts that include perioperative anesthetic care for WLS patients (7)(8)(9). Multimodal postoperative pain management strategies have been effectively used after WLS (10)(11)(12). New target areas for outcomes research include the effects of rigorous intra-and postoperative glycemic control as To reevaluate and update evidence-based best practice recommendations published in 2004 for anesthetic perioperative care and pain management in weight loss surgery (WLS), we performed a systematic search of English-language literature on anesthetic perioperative care and pain management in WLS published between April 2004 and May 2007 in MEDLINE and the Cochrane Library.…”

Section: Introductionmentioning

confidence: 99%

Update on Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery, 2004–2007

Schumann

Jones

Cooper

et al. 2009

Obesity

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To reevaluate and update evidence‐based best practice recommendations published in 2004 for anesthetic perioperative care and pain management in weight loss surgery (WLS), we performed a systematic search of English‐language literature on anesthetic perioperative care and pain management in WLS published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. We identified relevant abstracts by using key words, retrieved full text articles, and stratified the resulting evidence according to systems used in established evidence‐based models. We updated prior evidence‐based best practice recommendations based upon interim literature. In instances of controversial or inadequate scientific evidence, the task force reached consensus recommendations following evaluation of the best available information and expert opinion. The search yielded 1,788 abstracts, with 162 potentially relevant titles; 45 were reviewed in detail. Despite more information on perioperative management of patients with obstructive sleep apnea (OSA), evidence to support preoperative testing and treatment or to guide perioperative monitoring is scarce. New evidence on appropriate intraoperative dosing of muscle relaxants allows for greater precision in their use during WLS. A novel application of α−2 agonists for perioperative anesthetic care is emerging. Key elements that may enhance patient safety include integration of the latest evidence on WLS, obesity, and collaborative multidisciplinary care into clinical care. However, large gaps remain in the evidence base.

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“… 58 Perioperative use of IV ketorolac after laparoscopic gastric bypass surgery for morbid obesity helped provide an earlier discharge from the PACU and better outcomes. 59 Preemptive analgesia using either ketorolac or parecoxib (IV, 30 minutes prior to incision) showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion. 60 …”

Section: Pharmacological Managementmentioning

confidence: 91%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity

Cited by 57 publications

References 10 publications

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

Update on Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery, 2004–2007

Postoperative pain management in the postanesthesia care unit: an update

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