Perioperative Opioid-sparing Strategies: Utility of Conventional NSAIDs in Adults

Bleeding After a Single Dose of Ketorolac in a Postoperative Patient

“…Ketorolac in clinical settings has a higher analgesic to anti-inflammatory ratio compared to other NSAIDs [1]. Ketorolac reduces opioid use via literature review multistudy analysis by 9%-66% [1,2]. For instance, data suggest that although the onset of ketorolac is slower than that of the opioid morphine, the effectiveness is similar and duration longer [10].…”

“…Opioids are efficacious analgesics, but they come with side effects like constipation and drug abuse. There is an increasing tendency to use nonsteroidal medication to avoid the opioid side effect [1,2]. Ketorolac, like other nonsteroidal anti-inflammatory agents (NSAIDs), inhibits the enzyme cyclooxygenase (COX) and does not cause constipation or dependence [1].…”

“…There are case reports of patients bleeding postoperatively from ketorolac use; however, meta-analysis has refuted that concern [ 1 , 2 ]. Opioids are efficacious analgesics, but they come with side effects like constipation and drug abuse.…”

The Opioid Epidemic in the United States: A Call for Practice Change in Pediatric Outpatient Surgeries

“…7 The adverse effects in the adult population have been well established and include sedation, respiratory depression, dizziness, ileus, constipation, opioid induced hyperalgesia/pain sensitivity, immunosuppression, and hormonal dysfunction. 8,9 Evidence regarding adverse effects specific to opioid use in the pediatric population is more limited, in part because research involving pediatric patients and opioids is limited by ethical issues involved in enrolling pediatric patients for clinical trials. Major adverse effects of opioids well known to the pediatric population include dizziness, sedation, dose-related respiratory and CNS depression leading to apnea and death, constipation, and nausea and vomiting.…”

“…12 Interestingly, comparisons between pain control using narcotic and non-narcotic medications postoperatively have demonstrated similar efficacy in treating pain in adults as evidenced by similar reported pain scores. 9 Given the lower risks associated with non-narcotic pain medication use and the similar efficacy of non-narcotics in pain control, the use of narcotics in the pediatric population should be limited. Narcotics should be considered a second line treatment and avoided, if possible, especially for outpatient surgeries.…”