The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

Abstract

Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.

Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant

“…These observed changes agree with other reports of signiWcant granulocytosis and lymphopenia occurring in human patients after trauma caused by accidental injury or elective surgery [12][13][14][15][16][17][18]. The lymphocyte count falls within hours of the start of major surgery and continues to fall during the day of operation.…”

Systemic Inflammatory Response Syndrome in Surgical Patients

“…The increased release of cortisol as the body’s response to stress or administration of adrenaline during major surgical procedures also affects the increase in the number of leukocytes ( 8 , 9 ). Hong ( 10 ) published the results of a study that analyzed changes in the number of leukocytes in patients who underwent laparoscopic surgery due to endometriosis comparing preoperatively administration of ketorolac vs placebo. Preoperative ketorolac reduced postoperative pain and influenced the WBC response.…”

A prospective, randomized, double-blind, placebo-controlled trial of multimodal intraoperative analgesia for laparoscopic excision of endometriosis

“…The findings by Hong et al (27) poses the important question of whether all components of our intraoperative multimodal regimen are required to optimally reduce postoperative pain or analgesic requirements, or whether the administration of a systemic (rectal or parenteral) NSAID alone is just as effective.…”

“…Randomized controlled trials have been published assessing the value of pre-or intraoperative unimodal analgesia in women specifically undergoing laparoscopic excision of grade 3 or 4 endometriosis (9,27), and have demonstrated a reduction in postoperative pain scores and opioid requirements with preoperative IV ketorolac (27) but no reduction in postoperative pain scores with intraoperative ropivacaine sprayed onto the peritoneal excision sites under direct vision (9). The findings by Hong et al (27) poses the important question of whether all components of our intraoperative multimodal regimen are required to optimally reduce postoperative pain or analgesic requirements, or whether the administration of a systemic (rectal or parenteral) NSAID alone is just as effective.…”