Recovery from Outpatient Laparoscopic Tubal Ligation is Not Improved by Preoperative Administration of Ketorolac or Ibuprofen

Abstract

The analgesic efficacy of a single dose of ketorolac or ibuprofen given preoperatively was assessed in healthy outpatients undergoing general anesthesia for laparoscopic tubal ligation. Fifty patients were randomized to receive either ketorolac 60 mg intravenously (i.v.), ibuprofen 800 mg orally, or placebo in a double-blind manner. Anesthesia was induced with fentanyl 2 micrograms/kg, thiopental 5 mg/kg, and either vecuronium 0.1 mg/kg or succinylcholine 1.5 mg/kg i.v. and was maintained with nitrous oxide 67% in oxygen and isoflurane. Patients were assessed at 15-min intervals in the postanesthesia care unit (PACU) and treated for pain with i.v. morphine by protocol. Patients were evaluated for pain, analgesic requirements, side effects, and recovery times. After discharge, patients completed questionnaires to assess pain, analgesic use, and side effects 6 and 24 h postoperatively. Parenteral morphine was required in 80% of patients in the control group, and 73% of patients in both treatment groups, and the difference was not statistically significant. The dose of parenteral morphine required in the PACU was not different between the control (7 +/- 1.2 mg), ibuprofen (5.7 +/- 1.4 mg), and ketorolac (6.1 +/- 1.4 mg) groups. There was no difference between groups in terms of pain visual analog scale (VAS) scores, fatigue VAS scores, recovery times, or the incidence of postoperative nausea and vomiting. The preoperative administration of either parenteral ketorolac or oral ibuprofen did not decrease postoperative pain or side effects when compared to placebo in this outpatient population.

Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta‐analysis

“…Some of these mediators evoke pain (histamine, acetylcholine and bradykinin), and others (such as prostaglandins) cause hyperalgesia, which is characterized by decreased pain threshold and increased sensitivity to supra threshold stimuli (Trombelli et al, 1996). The preoperative administration of NSAIDs may augment postoperative analgesia, as seen in the present study (95% CI, À0.61 to À0.14; 31 comparisons), chiefly by the COX-2 inhibitors class (95% CI, À0.95 to À0.33; 13 comparisons), by preventing the establishment of central sensitization in nociceptive pathways (Higgins et al, 1994;Celik et al, 2005).…”

“…In the case of COX-2 inhibitors, these agents act to inhibit cyclooxygenase and reduce prostaglandin synthesis both in the spinal cord and at the periphery (McCormack, 1994) and provide analgesia by decreasing peripheral pain receptor sensitivity to mechanical stimulation and reducing tissue inflammation (Higgins et al, 1994). Injury to tissue during surgical procedures results in the release of chemical mediators of inflammation.…”

“…This could be due to the drug preparations having unsuitable pharmacokinetic properties where peak activity is too slow to achieve sufficient postoperative analgesia (Reiter et al, 2003). The fact that opioid analgesics have many unwanted side-effects such as nausea, vomiting, urinary retention, sedation, respiratory depression, drug dependence, dizziness and dry mouth (Higgins et al, 1994;Liukkonen et al, 2002;Akca et al, 2004;Horattas et al, 2004) tends to reduce their appeal further by complicating recovery and lengthening hospitalization (Higgins et al, 1994). Nevertheless, combinations of analgesics with different pharmacokinetic properties, either two opioids or an opioid with another class of analgesic agent, may increase analgesic effectiveness while reducing the worst of the side-effects (Culebras et al, 2007).…”

“…Three RCTs used ketorolac [one study, high dose (Higgins et al, 1994); two studies, medium dose (Trombelli et al, 1996;Wilder-Smith et al, 2003)], two used acetaminophen [one study, high dose (Dahl et al, 1997); one study, medium dose (Kesimci et al, 2011)], one used diclofenac sodium (one study, medium dose; Alanoglu et al, 2005) and one used etofenamate (one study, high dose; Sen et al, 2009a; Table 1). All seven RCTs compared a single NSAID group to a single placebo group (Table 1).…”

Preoperative diclofenac is a useful adjunct to spinal anesthesia for day-case varicose vein repair

“…1 , 4 7 Four other studies showed preoperative diclofenac or ketorolac to be ineffective in controlling postoperative pain. [8][9][10][11] In an attempt to clarify these results, we investigated the clinical usefulness of diclofenac 50 mg po administered one hour before day-case varicose vein repair performed under spinal anesthesia.…”