Effect of Pre-Treatment with Ketorolac Tromethamine on Post-operative Pain Following Periodontal Surgery: A Randomized Crossover Clinical Trial

Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material & Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg & Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.

Efficacy and safety of parecoxib versus ketorolac tromethamine for perioperative analgesia：a systematic review / 中国药房

OBJECTIVE To compare the efficacy and safety of parecoxib and ketorolac tromethamine for perioperative analgesia， and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP， Wanfang Data， Baidu and Google， randomized controlled trials （RCT） about parecoxib （trial group） versus ketorolac tromethamine （control group） for perioperative analgesia were collected from the inception to Jun. 17th， 2022. After screening the literature and extracting the data， the quality of the included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis， sensitivity analysis and publication bias analysis were performed with RevMan 5.4 software. RESULTS A total of 12 RCTs were included， with 1 118 patients. Meta- analysis results showed that at the time of administration before anesthesia induction， there was no statistically significant difference between the 2 groups in visual analogue scale （VAS） [MD＝－0.16， 95%CI （－0.41， 0.09）， P＝0.20]， numerical rating scale （NRS） [MD＝0.01， 95%CI （－0.36， 0.38）， P＝0.97]， postoperative bleeding [MD＝0.15， 95%CI （－0.63， 0.93）， P＝0.71]， and consumption of opioid analgesics [MD＝0.12， 95%CI （－0.77， 1.01）， P＝0.79]. At the time of postoperative administration， VAS and bleeding volume at 48 h after operation of trial group were significantly lower than control group （P＜0.05）. The results of subgroup analysis by different com assessment time points showed that the VAS of patients in trial group at 0 h after operation were significantly lower than control group at the time of administration before anesthesia induction； at the time of postoperative administration， VAS of patients in the trial group at 12 h and 48 h after operation were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups [RR＝0.93，95%CI （0.78，1.11），P＝0.43]. The results of subgroup analysis according to different types of adverse reactions showed that the incidence of nausea and vomiting of trial group was significantly lower than control group， and the incidence of other adverse reactions was significantly higher than control group （P＜0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was great possibility of publication bias in this study. CONCLUSIONS The efficacy of parecoxib is equivalent to that of ketorolac tromethamine for perioperative analgesia before operation； at the time of administration after operation， parecoxib has better analgesic effect and less postoperative bleeding； the incidence of nausea and vomiting caused by parecoxib is lower at any time of administration.

Analgesia postoperatoria para craneotomías en pediatría: experiencia en un Hospital de Tercer Nivel / Postoperative analgesia for craniotomies in pediatrics: experience in a Third Level Hospital

Resumen: Introducción: Existe la creencia de que los pacientes no experimentan dolor intenso después de cirugía intracraneal. La estimulación simpática secundaria a dolor puede ocasionar hipertensión intracraneal y sangrado postoperatorio. Es controvertido el uso de opioides para analgesia postcraneotomías por temor a sus efectos colaterales que pueden enmascarar signos de alteración neurológica. En pediatría hay estudios limitados. Objetivo: Describir el nivel de control del dolor postcraneotomías al usar buprenorfina ketorolaco y ondansetrón en pacientes pediátricos. Métodos: Estudio de cohorte descriptivo. Incluimos niños de 0-17 años programados para cirugía intracraneal electiva. Para el control del dolor se administró buprenorfina, ketorolaco y ondansetrón en infusión por 30 horas. Se investigó dolor al iniciar la infusión a las cuatro, ocho, 12, 24 y 30 horas; variables hemodinámicas y grado de sedación. Resultados: 109 pacientes fueron incluidos. Se observó adecuado control del dolor en 71.56%, 28.4% tuvo control insuficiente con una diferencia estadísticamente significativa (p < 0.001). Hubo sedación moderada en 5.6% iniciando la infusión y a las 24 horas (4.5%) sin repercusión hemodinámica. Se detectó náusea en 8.2% y vómito en 6.64%; no se presentó sedación profunda, ni depresión respiratoria. Conclusiones: Estos hallazgos sugieren que es una opción efectiva para tratar el dolor postcraneotomías en pediatría.

Abstract: Introduction: There is still a belief that patients do not experience intense pain after intracranial surgery. Sympathetic stimulation associated with pain can lead to elevated intracranial pressure and postoperative haemorrhage. There is controversy about the use of opioids for postoperative analgesia in craniotomies, owing to fear of its side effects, which can mask signs of neurological alteration. There are limited studies in the pediatric patient for post-craniotomy analgesia. Objective: To describe the postcraneotomies pain control level, using buprenorphine in partnership with ketorolac and ondansetron in pediatric patients. Methods: Descriptive cohort study. For postoperative pain control, patients were given continuous infusion buprenorphine, ketorolac and ondansetron for 30 hours. The main variables to investigate were pain at beginning of infusion, at four, eight, 12, 24 and 30 hours, hemodynamic variables and depth of sedation. Results: 109 patients were included. Adequate control of pain was observed in 71.56% of patients, whereas in 28.4% insufficient control was found, with a statistically significant difference (p < 0.001). There was moderate sedation in 5.6% of the patients at the start of infusion and at 24 hours (4.5%), without significant impact on hemodynamic variables. Nausea was found in 8.2% and vomiting in 6.64%. No deep sedation, or respiratory depression was presented. Conclusions: These findings suggest that is an effective option to treat postcraneotomy pain in pediatric patients.

Analgesia preventiva versus analgesia postoperatoria con paracetamol + ketorolaco en colecistectomía laparoscópica / Preventive versus postoperative analgesia with paracetamol + ketorolac in laparoscopic cholecystectomy

Resumen: Introducción: La analgesia preventiva es la administración de un fármaco o realización de una intervención capaz de inhibir o bloquear la respuesta dolorosa con la finalidad de prevenir el dolor asociado a un procedimiento quirúrgico. Objetivo: Identificar si existen diferencias en el control del dolor postoperatorio utilizando analgesia preventiva versus analgesia postoperatoria, manejado con paracetamol + ketorolaco en pacientes sometidos a colecistectomía laparoscópica electiva. Material y métodos: Ensayo clínico controlado, comparativo, aleatorizado, longitudinal, unicéntrico, prospectivo, homodémico, doble ciego; con 70 pacientes divididos en dos grupos. En el grupo 1 que recibió analgesia preventiva se usó paracetamol + ketorolaco y en el grupo 2 se utilizó el mismo esquema de manera postquirúrgica inmediata. Se midió tensión arterial, frecuencia cardíaca, escala verbal numérica del dolor y presencia de efectos secundarios de los fármacos en distintos momentos. Prueba estadística T de Student con significancia estadística de p < 0.05. Resultados: A los 60 minutos la tensión arterial diastólica en el grupo 1 tuvo diferencia de medias -4.20 con p = 0.027 y la escala verbal numérica presentó diferencia de medias de -0.71 y p = 0.002. A las cuatro horas la tensión arterial diastólica mostró diferencia de medias de -3.5 y p = 0.033. Las náuseas se constataron en 2.9% para el grupo 1 y 8.6% para el grupo 2. Conclusiones: Existe una mejor respuesta al dolor en aquellos pacientes que reciben un esquema de analgesia preventiva en comparación a los que se les administra un esquema de analgesia postquirúrgica inmediata.

Abstract: Introduction: Preventive analgesia is the administration of a drug or performance of an intervention capable of inhibiting or blocking the painful response in order to prevent the pain associated with a surgical procedure. Objective: To identify whether there are differences in postoperative pain control using preventive analgesia versus postoperative analgesia, managed with paracetamol + ketorolac in patients undergoing elective laparoscopic cholecystectomy. Material and methods: Controlled clinical trial, randomized, longitudinal, unicentric, prolective, homodemic, double blind; 70 patients divided into two groups. group 1 received preventive analgesia using paracetamol + ketorolac and group 2 same scheme in an immediate postsurgical manner. Bloodpressure, heartrate, numerical verbal scale of pain and presence of side effects of drugs at different times were measured. Student's t-test with statistical significance of p < 0.05. Results: At 60 minutes the diastolic blood pressure in group 1 had difference of means -4.20 with p = 0.027 and numerical verbal scale presented difference of means of -0.71 and p = 0.002. At four hours diastolic bloodpressure showed difference of means of -3.5 and p = 0.033. Nausea was reported in 2.9% for group 1 and 8.6% for group 2. Conclusions: There is a better response to pain in those patients who receive a preventive analgesia scheme compared to those who are administered an immediate post-surgical analgesia scheme.

To Evaluate the Effect of Ketorolac Tromethamine, Tramadol and Placebo During Periodontal Surgery: A Double Blind Study

Objectives: The efficacy of single oral dose KetorolacTromethamine, Tramadol and Placebo was evaluated in paincontrol after periodontal surgery.Materials and Methods: The study design is a split mouthstudy involving three quadrants of the same patient. 20patients requiring flap surgeries in at least three quadrantswere recorded. Patients were randomly divided into threegroups as per the medications given, either 10 mg ketorolac or50 mg tramadol or placebo tablets at least 30 minutes beforeadministration of local anesthesia (LA). The duration of surgeryfrom the time of incision to the placement of the last suture isrecorded. After the completion of the surgery, patients wereasked to rate their subjective operative pain intensity using avisual analog scale.Results: Differences were statistically significant in VAS scorebetween ketorolac and placebo, and tramadol and placebogroup. Comparison of sum of pain intensity showedsignificantly greater pain levels in the placebo than in theketorolac group and tramadol group.Conclusion: The results of this single-dose, parallel-group,and double blind placebo-controlled study showed that 10-mgketorolac and 50-mg tramadol administered immediately beforeperiodontal surgery was effective for better response by thepatient during the procedure. However, ketorolac and tramadolpremedication neither affected delayed pain levels, norpostoperative analgesic consumption.

Management of Acute Trauma Pain in the Emergency Department – A Comparison of Intramuscular Ketorolac, Diclofenac and Tramadol

Introduction: Trauma is a chief cause of pain and suffering. Alarge number of studies have shown that pain relief provided topatients in the ED is grossly inadequate. Diclofenac, tramadoland ketorolac are the most commonly used intramuscularanalgesics and hence selected for this comparative study.The aim of this study was to compare the analgesic duration,efficacy and side effect profile of diclofenac, tramadol andketorolac administered intramuscularly in patients whopresented to the ED with acute trauma pain.Material and methods: In a prospective double-blinded study,90 patients presenting to the ED with musculoskeletal traumawere randomly selected and divided into 3 groups - GroupA received 1 ml (50mg) Diclofenac; Group B received 1ml(30mg) Ketorolac; Group C received 1ml (50mg) Tramadol.The efficacy of the drug was measured by observing: painscore, onset & duration of action, rescue drug use, and thepatient’s global impression of efficacy of drugs. Collecteddata was analysed using ANOVA.Results: The time taken to administer the first dose of rescueanalgesic was significantly (P <0.05) delayed in the Group B(276mins). Overall, mean scores were significantly better with(Group B) and were not significantly different between other(Group T) and (Group A).Conclusion: Ketorolac was a better analgesic compared todiclofenac and tramadol in managing acute trauma pain.

Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids / Incidência de edema macular cistóide após cirurgia de catarata de rotina com a utilização de AINEs isoladamente ou com corticosteroides

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-ste­roidal anti-inflammatory drugs with corticosteroids.

RESUMO Objetivo: Avaliar a taxa de desenvolvimento do edema macular cistóide em pacientes submetidos à cirurgia de catarata em quatro esquemas terapêuticos diferentes. Métodos: O presente estudo é uma análise retrospectiva de 5.380 olhos após facoemulsificação não complicada na Wake Forest University. O período do estudo foi entre julho de 2007 e dezembro de 2012. Os pacientes receberam um dos quatro esquemas: cetorolaco genérico pós-operatório 0,4% e prednisolona 1%, cetorolaco 0,45% pós-operatório e prednisolona 1%, bromfenac 0,09% e a prednisolona 1% pós-operatório, bromfenaco 0,09% no pré-operatório e isoladamente no pós-operatório. Uma análise estatística foi realizada para avaliar as diferenças na taxa de desenvolvimento do edema macular cistóide entre os quatro diferentes regimes terapêuticos. O diagnóstico de edema macular cistóide exigiu uma piora da visão e uma evidência de aumento da espessura macular na tomografia de coerência óptica. Resultados: A taxa global de edema macular cistóide foi de 0,82%. O tratamento com cetorolaco genérico pós-operatório 0,45% e prednisolona 1% demonstrou a maior taxa de desenvolvimento de edema macular cistóide (2,20% dos casos). O cetorolaco 0,45% e a prednisolona 1% no pós-operatório exibiram taxas intermediárias de desenvolvimento de edema macular cistóide (0,90% dos casos). A administração de bromofenac 0,09% e de prednisolona 1% no pós-operatório apresentou taxas interme­diárias de desenvolvimento de edema macular cistóide (0,44% dos casos). O bromfenac 0,09% no pré e pós-operatório isoladamente resultou na menor taxa de desenvolvimento de edema macular cistóide (0,09% dos casos). A taxa de edema macular cistóide foi significativamente menor quando o bromfenac foi utilizado isoladamente em relação ao esquema onde cetorolaco e a prednisolona foram usados (OR 0,043, 95% CI 0,002 a 0,312; p<0,001). Conclusões: O edema macular cistóide pós-cirurgia de catarata desenvolveu-se com menor frequência após o tratamento tópico de medicamentos anti-inflamatórios não esteroidais, comparado às outras terapias avaliadas. Bromfenac, sem corticosteróides, alcançou taxas mais baixas de edema macular cistóide vs. Várias combinações em comparação com as várias combinações de drogas anti-inflamatórias não esteroidais com corticosteróides.

Comparative Evaluation of Bepotastine Besilate Versus Olopatadine And Ketorolac Combination on Upper Tarsal Conjunctival Brush Cytology in Patients of Vernal Keratoconjunctivitis

Comparative evaluation of bepotastine besilate versus olopatadine and ketorolac combination onupper tarsal conjunctival brush cytology in patients of vernal keratoconjunctivitis. This studywas a prospective, open label, randomized, comparative clinical study. 100 patients of vernalkeratoconjunctivitis between 6 to 20 years of age of either sex willing to give informed consentwere enrolled in the study. In Group 1, 50 patients received Bepotastine besilate (0.15%) eyedrops twice daily for 8 weeks whereas in Group 2, 50 patients received Olopatadine (0.2%) andKetorolac (0.4%) combination eye drops twice daily for 8 weeks. Upper tarsal conjunctival brushcytology for eosinophil count was done in both the drug groups during the baseline and at 8th weekduring the treatment. It was found that after the 2 months of drug therapy, patients in both thegroups showed reduction in the eosinophil count. However, there was no statistically significantdifference between the two treatment groups at the baseline and at 8th week. There was 32%reduction in group A versus 28% reduction in group B in eosinophil count at the end of 8th weekcompared to baseline. Both bepotastine besilate versus olopatadine and Ketorolac combinationwere found to be effective in reducing the eosinophil count in patients of VKC.

A Comparative Study Between Intravenous Ketorolac and Intravenous Paracetamol to Alleviate Post-Intubation Sore Throat

Background: Context: Complains of pain in throat have been recorded in patients subjected to intubation of the trachea to such an extent as requiring analgesic interventions.In the modern multi-modal analgesia approach, non-opioid and NSAID group of drugs are in vogue to provide perioperative analgesia. Ketorolac and Paracetamol are two such drugs employed to treat surgical pain. Aim: To study and compare the effectivity of Ketorolac and Paracetamol in decreasing throat pain following endotracheal intubation. Settings and design: Prospective randomised parallel assigned single blind control study. Methods: Conducted on 120 consenting adult patients who required endotracheal intubation for surgery.They were divided into 3 groups of 40 patients each - C, K and P.Group K patients were premedicated with IV Inj.Ketorolac and Group P patients with IV Inj.Paracetamol 10minutes before induction of anaesthesia.Group C patients were the Control group.All patients were administered standard identical general anaesthetics .After recovery from anaesthesia, the incidences and severity of pain in throat was assessed and graded.The observations were tabulated and statistically analysed. Statistical analysis used: OpenEpi online software. Results: Both Ketorolac and Paracetamol decreased incidences and severity of throat pain. Ketorolac premedication provided better results than Paracetamol. Conclusion: Intravenous Ketorolac and Paracetamol both lessen sore throat caused by tracheal intubation.

Formulation and pharmacopoeial quality evaluation of ketorolac tromethamine IR tablet and comparison with marketed product

This study describes the formulation of immediate release Ketorolac tromethamine (KT) 10-mg tablet by directcompression method; evaluation of their compliance to various Pharmacopoeial quality parameters, i.e., weightvariation, friability, hardness, thickness, moisture content, disintegration, assay, and dissolution; and their comparisonwith marketed brands for determination of pharmaceutical equivalency. Five formulations of KT were prepared(coded as FKT1, FKT2, FKT3, FKT4, and FKT5) by direct compression method using different superdisintegrants.Micrometric properties of the mixtures of the drug and the excipients prepared for formulation were evaluated. Qualityevaluation of the five different formulations and randomly selected four different brands of KT 10-mg tablets purchasedfrom the local market (coded as LKT1, MKT2, MKT3, and SKT4) were performed according to Pharmacopoeia. Theresults were obtained by UV-Vis spectrophotometer and all the dissolution profiles were characterized by the zeroorder kinetics. All the brands of KT and developed formulations met the official specification except SKT4 whichshowed excessive moisture content of 7.18%. None of the tested brands of KT were found to be pharmaceuticallyequivalent, whereas two developed formulation were pharmaceutically equivalent with the in house benchmark(MKT2) from which their interchangeability can be suggested.

Effect of Tramadol Combined with Ketorolac Tromethamine in 30 Case of Patients of Patient-controlled Intravenous Analgesia after Gynecological Laparoscopic Surgery / 医药导报

Objective To observe the effect of combination use of tramadol and ketorolac tromethamine for patientcontrolled intravenous analgesia (PCIA) after gynecological laparoscopic surgery. Methods Ninety patients with American Society of Anesthesiologists (ASA) grade I or Ⅱ undergoing gynecological laparoscopic surgery under general anesthesia were randomly divided into three groups: group T (using tramadol for PCIA) , group TK (using tramadol and ketorolac tromethamine for PCIA) and group K (using ketorolac tromethamine for PCIA) . The visual analog scale (VAS) scores at rest and moving and Ramsay sedation scale(Ramsay) scores were recorded at 1 h (t1) ,4 h (t2) ,8 h (t3) , 12 h (t4) , 24 h (t5) , 36 h (t6) , 48 h (t7) after surgery.The total dosage of rescue analgesia drug and the times of needing rescue analgesia were recorded. Adverse reactions were also recorded. Results VAS scores at rest in t 1,t2,t3,t4,t5 and t6 after surgery were significantly lower in group T and group TK than in group K(P<0.05) . VAS scores at movement time was not significantly different. After surgery,incidence rate of nausea,vomiting,dizziness or sleepiness was significantly higher in group T than in group TK and group K(P<0.05) . The total dosage of rescue analgesia drug in group K was significantly higher than in group T and in group TK (P<0.05) . In 24 h after surgery,patients pressed the button of PCIA (2.89±0.597) times in group TK,(3.05±0.574) times in group T,(6.50±0.859) times in group K.Ramsay scores at each time points after surgery were significantly increased (P<0.05) . Total dosage amount of rescue drugs and number of patients using rescue drugs were significantly higher in group K than in group T and group TK (P< 0.05) . Conclusion Combination use of tramadol and ketorolac tromethamine for PCIA after gynecological laparoscopic surgery has better analgesia effect with reduced side effects.

Comparative study on efficacy of Ketorolac in the management of post-operative pain when administered intravenously or intramuscularly

Background: In the earlier periods analgesia was restricted to surgical and immediate postoperative period. However, this was associated with a lot of morbidities to the patient in terms of surgical stress and increased requirements for analgesia as the pain persisted. Patient’s attitude and concern about postoperative pain need to be addressed preoperatively. Early interventions are essential for better long-term outcomes. Because of the multiplicity of mechanisms involved in postoperative pain, a multimodal analgesia regimen, with a combination of opioid and non-opioid analgesic drugs is often used to enhance analgesic efficacy, reduce opioid requirements and its side effects. Aim of the study: To compare the efficacy of ketorolac in the management of postoperative pain when administered intravenously or intramuscularly, to assess the efficacy of ketorolac by two routes of administration namely Intravenous (IV) and Intramuscular (IM). Materials and methods: This comparative study was done in 2015 in Pondicherry Institute of Medical Sciences, Pondicherry. Totally 60 patients undergoing elective surgeries under ASA I/II was selected and they were divided into two groups of 30 patients each. Postoperatively the patients were examined at half hourly intervals for the first 6 hours for pain and it was graded using Visual Analogue Scale (VAS). If VAS score was > 3, inj. Tramadol 1mg/kg IV was given as rescue analgesic and the time was noted. Any adverse effect such as dizziness, vomiting, nausea was also Maria Varun Raj, R. Ahila, Sangiev Koshy George. Comparative study on efficacy of Ketorolac in the management of postoperative pain when administered intravenously or intramuscularly. IAIM, 2019; 6(3): 164-169. Page 165 noted at half hourly interval for the first six hours following surgery. Total dosage and frequency of rescue analgesic tramadol in the 24 hour period were also calculated. Use of anti-emetics was noted. Results: Postoperative VAS score between the two groups was comparable at zero hours and after the first hour. However, at the 4th and 5th hour, there was a statistically significant difference in the scores between the two groups showing a better analgesic effect with the intramuscular route of administration of ketorolac. The mean VAS score at the end of the 5 th hour showed a statistical difference between the two groups (p=0.001). Postoperative VAS score between the two groups was comparable. However, at the 4th and 5th hour, there was a statistically significant difference in the score between the two groups. The mean duration of analgesia produced by intramuscular routes was found to be high when compared with that of the intravenous route and is statistically significant (p=0.001). The mean duration of analgesia produced by intramuscular routes was found to be high when compared with that of the intravenous route and is statistically significant. (p=0.001). Conclusion: We conclude that ketorolac can be used for postoperative analgesia in place of opioids in patients where opioid has to be avoided. Intramuscular administration provided more effective and prolonged pain relief when compared to intravenous administration.

Concurrent Use of Nefopam vs. Ketorolac with Opioid Analgesic for Post-operative Pain Management

OBJECTIVE: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. METHODS: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. RESULTS: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. CONCLUSION: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for postoperative pain management in general surgery patients in South Korea.

Ketorolac tromethamine combiend with sufentanil on median effective dose of analgesia after cesarean delivery / 中国基层医药

Objective@#To study the median effective dose of ketorolac tromethamine combined with different doses of sufentanil.@*Methods@#From February 2016 to June 2017, 60 cases of cesarean section were selected.According to the random number table method, they were divided into two groups, with 30 cases in each group.Group I was treated with sufentanil 0.75μg/kg+ dexmedetomidine 200μg, while sufentanil 1μg/kg+ dexmedetomidine 200μg was used in group II.The first two groups were added to pump 150 mg ketorolac tromethamine, gradually increased or decreased in accordance with 30mg effect according to satisfaction or dissatisfaction.The median effective dose of ketorolac tromethamine in the two groups was analyzed.@*Results@#After operation, the systolic blood pressure[(112.5±9.6)mmHg vs.(122.5±8.4)mmHg, (114.2±9.9)mmHg vs.(124.1±8.2)mmHg]and heart rate[(80.6±13.5)times/min vs.(90.5±16.5)times/min, (77.6±15.5)times/min vs.(88.2±18.8)times/min]in the two groups were significantly lower than those before operation (t=4.587, 5.248, 4.214, 3.983, all P<0.05). The VSA scores of the two groups decreased significantly[(6.8±2.4)points, (3.4±1.4)points, (2.1±0.9)points, (6.9±3.1)points, (3.5±1.7)points, (2.2±0.7)points], the difference was statistically significant at different time points (F=4.977, P<0.05). ED50 and 95% confidence interval of ketorolac tromethamine in the group I was 91.75mg, 78.69-106.98mg, which in the group II was 72.44mg, 60.40-86.90mg.@*Conclusion@#Ketorolac tromethamine combined with sufentanil has good analgesia effect, less adverse reaction.When sufentanil was given at 0.75 and 1μg/kg, the ED50 of ketorolac tromethamine were 91.75mg and 72.44mg.

Patterns of Ketorolac dosing by emergency physicians / 世界急诊医学杂志（英文）

@#BACKGROUND: Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAIDs) that is widely used in the emergency department (ED) for the treatment of moderate-to-severe pain. Ketorolac, like other NSAIDs, exhibits an analgesic ceiling effect and previous research suggests that 10 mg is possibly the ceiling dose. Do the patterns of ketorolac dosing by emergency physicians follow its analgesic ceiling dose? METHODS: This was a single center retrospective, descriptive study to characterize patterns of ketorolac administration in ED patients. Data for all patients who received ketorolac during the ten year study period from January 1, 2003 to January 1, 2013 were collected from the electronic medical record of an urban community ED with an annual volume of 116935 patients. RESULTS: There were 49605 ketorolac administrations during the study period; 38687 (78%) were given intravenously, 9916 (20%) intramuscularly, and 1002 (2%) orally. Through the intravenous route, 5288 (13.7%) were 15 mg, 32715 (84.6%) were 30 mg, 15 (0.03%) were 60 mg, and 669 (1.7%) were other varying doses. Through the intramuscular route, 102 (1.0%) were 15 mg, 4916 (49.6%) were 30 mg, 4553 (45.9%) were 60 mg, and 345 (3.5%) were other varying doses. The most common diagnoses at discharge were renal colic (21%), low back pain (17%) and abdominal pain (11%). CONCLUSION: The data show that ketorolac was prescribed above its ceiling dose of 10 mg in 97% of patients who received intravenous doses and in 96% of patients receiving intramuscular doses.

Liposomes as potential carriers for ketorolac ophthalmic delivery: formulation and stability issues / Liposomes as potential carriers for ketorolac ophthalmic delivery: formulation and stability issues

ABSTRACT Drug delivery to treat ocular disorders locally is a challenging endeavor. Traditional ocular dosage form - eye drops - exhibits poor availability, consequently inefficient therapeutic response. The objective of the study was to formulate and characterize a ketorolac tromethamine ocular system with a prolonged release pattern based on liposomes as a vesicular carrier and to design once daily liquid preparation realizing the thermal in situ gelation principle. Liposomes were prepared by film hydration method. The influence of cholesterol concentration, pH and volume of hydration medium, and type and concentration of charging imparting agents were studied. Liposomes were characterized via, morphological examination, vesicular size, and encapsulation efficiency, and in vitro release performance, moreover its stability was assessed. The results obtained highlighted that liposomes showed a closed vesicular multi-lamellar structure. Ketorolac was successfully encapsulated within the liposomal structure in a cholesterol and charge inducing agent concentration-dependent behaviour. The dispersion of liposomes within thermosensitive Poloxamer in situ gel was able to retard the release of the drug by diffusion providing a controlled prolonged delivery. The liposomal formulations were physically stable for six months. Ketorolac tromethamine in situ liposomal gel representing an efficient alternative in terms of ocular retention and patient compliance when compared with conventional eye drops.

Efficacy of preemptive analgesia with ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine for circumcision in pediatric patients / 临床麻醉学杂志

Objective To investigate the efficacy of preemptive analgesiawith ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine for circumcision in pediatric patients.Methods Forty-five pediatric patients with ASA grade Ⅰ undergoing elective circumcision were randomly divided into 3 groups (n=15 each).The same intravenous compound anesthesia was used in the three groups.The pediatric patients underwent ultrasound-guided modified dorsal penile nerve block with a mixture of 0.1 ml/kg of 0.2% ropivacaine and 0.8% lidocaine before operation in group A and group B.The pediatric patients were given ketorolac tromethamine 1 mg/kg intramuscular injection before operation in group A and group C.The total consumption of propfol and sufentanil, occurrence of intraoperative body movement and respiratory depression, emergence time, time from waking up to going out of PACU and adverse reactions such as postoperative agitation, nausea, vomiting and pruritus were aslo recorded.The requirement for postoperative paracetamol suppositories was recorded.Results Compared with group C, the total consumption of propfol and sufentanil were significantly decreased, incidence of body movement andrespiratory depression were significantly decreased, the emergence time and time from waking up to going out of PACU was significantly shortened, requirement for paracetamol suppositories were significantly decreased in group A and group B(P<0.05).Compared with group B, incidence of requirement for paracetamol suppositories was significantly decreased in group A (P<0.05).No pediatric patients developed postoperative nausea, vomiting, pruritus and incidence of emergence agitation had no statistical difference in the three groups.Conclusion Preemptive analgesia with ultrasound-guided modified dorsal penile nerve block combined ketorolac tromethamine is safe and effective when used for circumcision in pediatric patients, and it has good efficacy of postoperative analgesia.

A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study / 대한마취과학회지

BACKGROUND: We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia. METHODS: One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 µg and ketorolac 180 mg in Group K, and fentanyl 600 µg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded. RESULTS: Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups. CONCLUSIONS: Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.

The effect of ketorolac and dexamethasone on the incidence of sore throat in women after thyroidectomy: a prospective double-blinded randomized trial / 대한마취과학회지

BACKGROUND: We evaluated the effect of two drugs with anti-inflammatory action, dexamethasone and ketorolac, on reduction of postoperative sore throat (POST) after general anesthesia with endotracheal intubation in patients undergoing thyroidectomy. METHODS: One hundred and ninety-two female patients scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy were enrolled in this prospective study. Participants were randomly allocated to receive intravenous medication; placebo (Group C, n = 45), ketorolac 30 mg immediately before intubation (Group Kpre, n = 47), ketorolac 30 mg at the end of surgery (Group Kpost, n = 45) and dexamethasone 10 mg (Group D, n = 43). The incidence and severity of POST and hoarseness were evaluated at 1, 6 and 24 hours after surgery. RESULTS: Incidences and severities of POST at rest and during swallowing in first 6 hours after extubation were comparable among 4 groups. At 24 hours postextubation, the incidence (P = 0.002, 95% CI of proportion differences; 0.05–0.39) and severity (P = 0.008) of POST during swallowing were significantly lower in group D than in group C. Kpre and Kpost groups did not show a greater reduction in POST than group C, despite lower rescue analgesic requirement at 1 hour after extubation in group Kpre (P = 0.006; 95% CI of proportion differences; 0.07–0.38). No intergroup differences were observed in incidences of hoarseness or adverse events. CONCLUSIONS: Intravenous administration of dexamethasone 10 mg, but not ketorolac, before induction of anesthesia reduces the incidence and severity of POST during swallowing at 24 hours after thyroidectomy.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.