Intraarticular Administration of Ketorolac, Morphine, and Ropivacaine Combined with Intraarticular Patient-Controlled Regional Analgesia for Pain Relief After Shoulder Surgery: A Randomized, Double-Blind Study

Axelsson, Kjell; Gupta, Anil; Johanzon, E; Berg, Elisabeth; Ekbäck, Gustav; Rawal, Narinder; Enström, Peter; Nordensson, Ulf

doi:10.1213/01.ane.0000297297.79822.00

Cited by 35 publications

(24 citation statements)

References 14 publications

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“…A far-superior randomized, double-masked investigation evaluated the efficacy of patient-controlled intraarticular analgesia following Bankart shoulder surgery [8•]. Fifty-one patients were randomized into one of two infusions: ropivacaine/morphine/ketorolac or isotonic saline.…”

Section: Single-injection Peripheral Nerve Blocksmentioning

confidence: 99%

Regional anesthesia at home

Cheng¹,

Choy²

2008

Current Opinion in Anaesthesiology

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Purpose of review To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. Recent findings The potential benefits and risks of regional anesthesia and analgesia at home are pertinent queries, and increased data regarding these topics are rapidly becoming available. Of particular interest is the use of continuous peripheral nerve blocks at home and their potential effect upon hospitalization duration and recovery profile. Summary Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.

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Section: Single-injection Peripheral Nerve Blocksmentioning

confidence: 99%

Regional anesthesia at home

Cheng¹,

Choy²

2008

Current Opinion in Anaesthesiology

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“…Bektas that assessed in his study morphine and intravenous paracetamol in patients with renal colic, finally, suggested the latter as an effective and harmless treatment for renal colic patients admitted to the emergency department [20]. Axelsson that examined a composition of ropivacaine, morphine, and ketorolac in reducing patients pain after shoulder surgery, showed that subjects who had received more ketorolac than morphine were more satisfied [21]. Although both kinds of drugs used in current study were titratable, but as previously expressed in the section "intervention" there was no need for titration in present work.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Intravenous Ketorolac versus Intravenous Morphine Sulfate on Pain Control in Patients with Acute Renal Colic: A Phase 3 Randomized Clinical Trial

Masaeli¹,

Khazaee²,

Shahabian³

2017

Foc Sci

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Introduction: Renal colic is an acute syndrome for which relieving the pain is known to be the best treatment. The aim of this randomized clinical trial was comparing the efficacy of intravenous ketorolac with intravenous morphine sulfate in relieving the acute pain of renal colic in patients referred to the emergency department of a tertiary care teaching hospital. Methods: 98 cases were selected via convenience sampling method from patients with a presumptive diagnosis of renal colic admitted in the emergency department of Besat Nahaja hospital of Tehran, Iran from March to May 2014 and randomly divided into two groups of equal size, ketorolac, and morphine sulfate. The patients' vital signs and pain intensity were observed at baseline of the study and after 10, 30, 60, 120 and 180 minutes of drug administration. Patients were also followed for side effects. The areaunder-the-curve (AUC) was used for pain assessment. Data were analyzed in SPSS 19 using T-test, Chi-square test, and Mann-Whitney test at significance level < 0.05. Results: Demographic and clinical characteristics of the two groups were similar before drug administration. Both drugs were equally effective in reducing pain over time (P-value = 0.17). Side effects of treatment with ketorolac, were significantly less than using morphine sulfate. The most common adverse effects caused by morphine sulfate, were dizziness and vomiting while nausea and vomiting were the most frequent side effects of using ketorolac. Conclusions: Findings of this study indicated that ketorolac and morphine sulfate were equally effective in relieving the pain of renal colic, but given the severity of side effects, ketorolac is the preferred drug.

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“…Improved postoperative pain control using the ISB method is linked to an earlier initiation of rehabilitation, as evident in other studies [ 18 ]. IA has been popular among surgeons because it is perceived as a simple and effective technique associated with improved analgesia, the reduced use of analgesics, and improved patients' satisfaction [ 3 , 19 , 20 ]. Savoie et al demonstrated improved analgesia and reduced analgesic requirements with a continuous IA of 0.25% bupivacaine (2 ml/h for 48 h) in patients undergoing subacromial decompression under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have reported that, IA was an effective alternative to ISB [ 3 , 19 ]. However, the results of the current study were identical to those of other studies, finding that ISB provided better pain control than IA [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

Park

Choi

et al. 2015

Korean J Pain

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BackgroundArthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS.MethodsFifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects.ResultsPostoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were 1.6 ± 2.3, 3.0 ± 4.9 and 7.1 ± 7.9 mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups.ConclusionsThis prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

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Intraarticular Administration of Ketorolac, Morphine, and Ropivacaine Combined with Intraarticular Patient-Controlled Regional Analgesia for Pain Relief After Shoulder Surgery: A Randomized, Double-Blind Study

Cited by 35 publications

References 14 publications

Regional anesthesia at home

Regional anesthesia at home

Effectiveness of Intravenous Ketorolac versus Intravenous Morphine Sulfate on Pain Control in Patients with Acute Renal Colic: A Phase 3 Randomized Clinical Trial

A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

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