Nalbuphine Versus Ketorolac as an Adjuvant to Local Wound Infiltration Anesthesia in Open Colorectal Surgery: A Prospective Randomized Controlled Study

Abstract

Introduction: Adding adjuvants to local wound infiltration (LWI) provides long analgesic duration with fewer adverse effects. We aimed to compare the clinical effects of nalbuphine and ketorolac as an adjuvant to LWI in patients undergoing open colorectal cancer surgery. Method: A total of 126 ASA I-III patients aged C 18 years who were scheduled for open colorectal cancer surgery were included. Patients were randomly assigned to receive LWI using 10 mL 0.75% ropivacaine, with 20 mL normal saline (group R), 10 mg nalbuphine in 1 mL (group RN), or 25 mg ketorolac in 0.8 mL (group RK). Analgesia duration was the primary outcome. The total 48-h postoperative morphine-equivalent consumption and additional rescue analgesia rates were recorded as key secondary outcomes. Results: Among 126 patients randomized, 124 completed the trial. The duration until the first press of the analgesia pump was significantly shorter in group R (median: 320.0 min) compared with group RN (median: 829.5 min) and group RK (median: 820.0 min) (P \ 0.001). The median difference in morphine consumption was 113.0 mg for group R vs. group RN (P \ 0.001), and 115.5 mg for group R vs. group RK (P \ 0.001). The proportion of patients using additional morphine within the first day after surgery in group R showed a higher relative risk (RR) compared with group RN (RR, 3.89; P = 0.001) and group RK (RR, 3.17; P = 0.001). There were no apparent differences between the RN and RK groups in any outcomes, whether in adjusted or unadjusted analysis. Conclusions: Among patients undergoing open colorectal cancer surgery, both nalbuphine and ketorolac infiltration achieved equally prolonged duration of analgesia and reduced morphine consumption compared with ropivacaine alone after surgery, suggesting that the equivalent analgesic dose of nalbuphine and ketorolac as local anesthetic adjuvants in LWI could have a similar analgesic effect. Trial Registration: ChiCTR1800019209.Yi-Feng Ren and Xi Fu have contributed equally as cofirst authors.

Pain management after open colorectal surgery

“…Ketolorac was given every 12 h as basic analgesia. Finally, Ren et al reported that ketorolac and nalbuphine associated with ropivacaine by local wound infiltration allowed a reduction in opioid consumption 10 . No basic analgesia was given.…”

Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients

“…In cases of open colorectal surgery, WI has been found to be less effective than epidural analgesia in terms of analgesic impact and functional recovery, though it is associated with a lower risk of adverse events such as hypotension [ 110 , 158 ]. Enhancements in the duration and quality of WI analgesia can be achieved by incorporating adjuvants such as nalbuphine or ketorolac [ 159 ]. Notably, while WI carries a risk for wound infection and other potential complications like systemic toxicity from the local anesthetic (particularly if used concurrently with TAP block), or bruising and hematoma from vascular perforation, such incidences are generally rare [ 160 ].…”