Management of postoperative pain in ophthalmic plastic surgery: a major review

Wladis, Edward J.; Rothschild, Michael; Rubinstein, Tal J.

doi:10.1080/01676830.2020.1793373

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…Although noted previously by Wladis et al, 11–14 the improved pain scores on the postoperative day 1 are somewhat unexpected. IVK is an antiinflammatory medication that inhibits cyclo-oxygenase and thus prostaglandin synthesis.…”

Section: Discussionsupporting

confidence: 54%

“…In addition, the current body of literature suggests that IVK associated hemorrhagic concerns in an operative setting are unfounded. Wladis et al did not identify a heightened risk of postoperative bleeding in orbitotomy surgery, 12,14 and this result concurs with studies from a wide array of surgical settings. 8,10,11,18…”

Section: Discussionmentioning

confidence: 52%

“…[1][2][3][4] In addition, the current body of literature suggests that IVK associated hemorrhagic concerns in an operative setting are unfounded. Wladis et al did not identify a heightened risk of postoperative bleeding in orbitotomy surgery, 12,14 and this result concurs with studies from a wide array of surgical settings. 8,10,11,18 This study expands upon the role of IVK oculoplastic procedures and further strengthens the principle that this medication is a safe, effective treatment to reduce postoperative pain regardless of when it is administered in the perioperative period.…”

Section: Discussionmentioning

confidence: 54%

“…[8][9][10] Furthermore, multiple sources suggest that the use of IVK in oculofacial surgery effectively and dramatically reduce pain scores and the requirement for opioid analgesics. [11][12][13][14] Ketorolac is a nonsedating, nonsteroidal antiinflammatory drug (NSAID) that inhibits cyclo-oxygenase (COX1 and COX2) and thus prostaglandin synthesis. In humans, IVK has greater than 99% bioavailability and its pharmacokinetics act in a linear fashion.…”

mentioning

confidence: 99%

“…8–10 Furthermore, multiple sources suggest that the use of IVK in oculofacial surgery effectively and dramatically reduce pain scores and the requirement for opioid analgesics. 11–14…”

mentioning

confidence: 99%

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Effect of Timing of Intravenous Ketorolac Administration on Pain in Orbitotomy Surgery

Lee

Tram

Wladis

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Intravenous ketorolac (IVK) is an effective and safe medication to reduce postoperative pain in the setting of oculofacial surgery. This study was undertaken to determine the impact of timing of IVK administration in orbital surgery on the reduction of postoperative pain score and opioid requirement.Methods: Patients either received IVK immediately before (n = 50), during (n = 50) or after (n = 50) orbital surgery or acted as controls (n = 50). Pain scores were assessed via an analog scale immediately after surgery and on the first postoperative day. The requirements for opioid analgesics were recorded. Statistical analyses were performed via a dedicated computerized software package.Results: One hundred fifty patients received IVK; 50 before incision (28 males, 22 females, mean age 52.2), 50 intraoperatively (20 males, 30 females, mean age 49.8) and 50 in the immediate postoperative period (26 males, 24 females, mean age = 55.3). Additionally, 50 patients acted as controls (26 males, 24 females, mean age 54). Immediately after surgery, administration of IVK resulted in statistically significant reduction in pain score regardless of the timing of dosing as compared with control patients (prior = 2.36, intraoperative = 2.34, postoperative = 2.46 vs. control 5.44, p < 0.0001). Eleven patients (22%) in the control group required opioids, whereas, in the IVK cohorts, only 2 (4%-preoperative), 1 (2%-intraoperative), and 1 (2%-postoperative) patients needed these medications (p = 0.0039).Conclusions: In the setting of orbital surgery, IVK reduced pain scores and opioid requirement, regardless of the timing of administration, as compared with patients that did not receive the medication.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 54%

mentioning

confidence: 99%

“…8–10 Furthermore, multiple sources suggest that the use of IVK in oculofacial surgery effectively and dramatically reduce pain scores and the requirement for opioid analgesics. 11–14…”

mentioning

confidence: 99%

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