Evaluation of Intravenous Ketorolac Administered by Bolus or Infusion for Treatment of Postoperative Pain A Double-blind, Placebo-controlled, Multicenter Study

Ready, L. B.; Brown, Colin R.; Stahlgren, LeRoy H.; Egan, Kelly J.; Ross, Brian K.; Wild, Lorie Rietman; Moodie, John; Jones, Stephen F.; Tommeraasen, Miles; Trierwieler, M.

doi:10.1097/00000542-199406000-00015

Cited by 110 publications

(59 citation statements)

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“…Typically, ketorolac is administered intermittently, but may also be administered off-label as a continuous infusion, a practice that is conducted at our institution in postoperative CABG patients. Continuous infusion ketorolac has already been shown to decrease opioid use and opioid associated adverse effects in other patient populations; however, the concern still exists for risk of cardiovascular adverse effects [4,5,6]. Intermittently dosed ketorolac has been evaluated in CABG and cardiovascular surgery patients and has not shown untoward adverse cardiovascular events [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

2016

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Background:Continuous infusion ketorolac is sometimes utilized for analgesia in postoperative coronary artery bypass graft (CABG) patients despite contraindications for use. Limited literature surrounds this topic; therefore, this study was conducted to evaluate the safety of this practice. Methods: This retrospective cohort study evaluated the primary outcome of mortality and secondary outcomes of incidence of bleeding and myocardial infarction (MI). All patients who underwent isolated CABG surgeries and received continuous infusion ketorolac during the study period were included. An equal number of randomly selected isolated CABG patients served as control patients. Electronic medical records and the Society of Thoracic Surgeons (STS) database were utilized to determine baseline characteristics and outcomes; Results: One hundred and seventy-eight patients met inclusion; 89 in each group. More patients in the control group underwent on-pump surgeries (78.6% vs. 29.2%, p = 0.01) and had higher STS risk scores (1.1% vs. 0.6%, p = 0.003). There was no difference in mortality between the ketorolac group and control group (2.2% vs. 3.3%, p = 0.605). Additionally, no patients experienced a MI and there was no difference in bleeding incidence (5.5% vs. 6.7%, p = 0.58); Conclusions: No association was found between continuous infusion ketorolac and increased risk of mortality, MI, or bleeding events in postoperative CABG patients. Considerations to differences in baseline characteristics must be made when interpreting results.

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Section: Introductionmentioning

confidence: 99%

Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

2016

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“…In addition, the only clinical studies that describe a continuous ketorolac infusion are in reference to cancer pain or were not randomized. 4,[8][9][10] To our knowledge, our findings are the first from a randomized, double-blind, placebo-controlled study to evaluate a continuous ketorolac infusion for postoperative pain control in patients who have undergone LDN or PNL.…”

Section: Discussionmentioning

confidence: 91%

“…Ketorolac is one of the few nonopioid medications available for intravenous and intramuscular use. 4 Patients and physicians may be apprehensive about using ketorolac because of the risk of bleeding, diathesis, or renal impairment. Previous studies have established the safety of bolus administration of ketorolac and have found that the use of ketorolac decreases length of stay, reduces narcotic requirements, and results in faster return to bowel function.…”

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confidence: 99%

A Double-Blind Randomized Controlled Trial of Continuous Intravenous Ketorolac vs Placebo for Adjuvant Pain Control After Renal Surgery

Grimsby

Conley

Trentman

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the efficacy and safety of a novel, continuous intravenous infusion of ketorolac, a powerful nonopioid analgesic, for postoperative pain control. Patients and Methods: A prospective, double-blind, randomized, placebo-controlled trial of a continuous infusion of ketorolac tromethamine in 1 L of normal saline vs placebo was performed in 135 patients aged 18 to 75 years after laparoscopic donor nephrectomy or percutaneous nephrolithotomy completed from October 7, 2008, through July 21, 2010. Primary study end points were the 24-hour differences in visual analog pain scores and total narcotic consumption, whereas secondary end points were differences in urine output, serum creatinine level, and hemoglobin level. Results: The study was stopped after randomization of 135 patients (68 in the ketorolac group and 67 in the placebo group) when interim analysis indicated that the difference in mean pain scores between the 2 groups (difference, 0.6) was smaller than the 1-point threshold set forth in the power calculations. No statistically significant change was noted in hemoglobin levels from preoperative to postoperative values (Pϭ.13) or in postoperative serum creatinine levels (Pϭ.13). Conclusion: Although continuous infusion of ketorolac produced only a modest decrease in the use of narcotics, it appears to offer a safe therapeutic option for nonnarcotic pain control. Trial Registration: clinicaltrials.gov Identifiers: NCT00765128 and NCT00765232

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“…First, the 30 mg dose of ketorolac may have been inadequate. We selected this dosage based on published recommendations;[1646474849] in Great Britain, the recommended dose is only 10 mg, nevertheless, doses of 60 mg have been used in the United States. [50]…”

Section: Discussionmentioning

confidence: 99%

No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study

Nistal-Nuño

2017

Saudi J Anaesth

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Background:Experimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements.Methods:In a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction.Results:There were neither significant differences in VAS scores between groups (P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point (P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group (P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h (P = 0.02) and 4 h (P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h (P = 0.013). The respiratory rate showed no differences between groups, except at 8 h (P = 0.017), 16 h (P = 0.011), and 24 h (P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate (P > 0.05).Conclusions:Preoperative ketorolac neither showed a preemptive analgesic effect nor was it effective as an adjuvant for decreasing opioid requirements or postoperative pain in patients receiving IV analgesia with tramadol after abdominal hysterectomy.

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Evaluation of Intravenous Ketorolac Administered by Bolus or Infusion for Treatment of Postoperative Pain A Double-blind, Placebo-controlled, Multicenter Study

Cited by 110 publications

References 0 publications

Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

A Double-Blind Randomized Controlled Trial of Continuous Intravenous Ketorolac vs Placebo for Adjuvant Pain Control After Renal Surgery

No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study

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