The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

PURPOSE: To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS: A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS: Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION: Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Controle da dor pós-operatória em odontologia com cetorolaco de trometamol / Control of postoperative pain in dentistry with ketorolac of trometamol

O controle da dor e da inflamação pós-operatória são constantes preocupações dos cirurgiões, bem como o bem-estar do paciente após o ato cirúrgico, esses fatores estão intimamente ligados ao sucesso dos procedimentos e técnicas aplicadas. O cetorolaco é um anti-inflamatório não esteroidal (AINE) não seletivo, que age indistintamente sobre as cicloxigenases 1 e 2 e está indicado no tratamento da dor pós-operatória ou processos dolorosos de intensidade moderada a grave. Esta revisão de literatura se propôs a elucidar os efeitos analgésicos e anti-inflamatórios do cetorolaco de trometamol aplicado tanto de forma preventiva quanto pre-emptiva no tratamento da dor, bem como suas reações adversas, apresentando vantagens e desvantagens deste fármaco. Diante da revisão de literatura abordada, os autores concluíram que: a analgesia pre-emptiva deve ser feita sempre que possível; o cetorolaco de trometamol apresenta maior eficácia analgésica que os opióides, porém, deve ser usado em curto prazo, pelo risco de desenvolver doenças gastrointestinais, além do cuidado da sua indicação que segue as recomendações comuns a todos os AINES empregados em odontologia.

The pain control and postoperatory inflammation are constant concerns of surgeons, as well as the welfare of the patient after surgery, these factors are closely linked to the success of the procedures and techniques. Ketorolac is a non steroid anti-inflammatory drug (NSAID) non-selective, which acts indiscriminately on cyclooxygenase 1 and 2 and is indicated for the treatment of postoperative pain or painful processes of moderate to severe intensity. This literature review aimed to elucidate the analgesic and anti- inflammatory ketorolac trometamol applied as a preventive and preemptive treatment of pain and its adverse reactions, presenting advantages and disadvantages of this drug. Given the literature review addressed, the authors concluded that: preemptive analgesia should be performed whenever possible; ketorolac trometamol shows greater efficacy than opioids, however, should be used in short term, at risk of developing gastrointestinal diseases, beyond the care of his statement following the recommendations common to all NSAIDs used in dentistry.

Comparación de ketorolaco sublingual contra metamizol endovenoso en el manejo del dolor posoperatorio en cirugía de corta estancia / Comparison of sublingual ketorolac vs. IV metamizole in the management of pain after same-day surgery

Introducción: El dolor posquirúrgico es uno de los retos más importantes en cirugía, los estudios comparativos con ketorolaco en pacientes con cirugía de corta estancia se han restringido generalmente a la administración intravenosa. Por lo tanto, comparamos la eficacia analgésica de ketorolaco sublingual y metamizol en cirugía de corta estancia. Material y métodos: Ensayo clínico controlado ciego simple; los pacientes recibieron 30 mg de ketorolaco sublingual o 1 g de metamizol endovenoso, cada ocho horas, durante las primeras 24 horas posoperatorio. Se evaluó dolor con la escala análoga visual (EVA). También fueron evaluados los efectos colaterales. Para el análisis estadístico se utilizó t de dos colas o U de Mann-Whitney y la prueba exacta de Fisher o χ2, además del cálculo de reducción de riesgo absoluto, razón de momios (OR), intervalo de confianza a 95 %, reducción del riesgo relativo y número necesario a tratar. Resultados: El consumo de analgésico suplementario fue mayor en el grupo de metamizol pero sin diferencia significativa (p = 0.286). Durante el estudio, la EVA promedio fue menor para ketorolaco que para metamizol, sobre todo a las ocho horas de posoperatorio, pero sin diferencia estadística (p = 0.06). La reducción del riesgo absoluto para cuadros de dolor severo fue de casi 5 % (OR = 1.78). No hubo diferencia en la presentación de efectos adversos (p = 0.642). Conclusiones: Tanto ketorolaco como metamizol demostraron un efecto comparable y pueden ser utilizados con seguridad.

BACKGROUND: Therapeutic pain is one of the most important outcome measures in surgery. Comparative studies investigating ketorolac efficiency in ambulatory surgery have generally been restricted to IV administration. We compared analgesic effectiveness of sublingual ketorolac and metamizole in short stay surgery. METHODS: This was a randomized single-blind clinical trial. All patients received either a three-dose (30 mg) of sublingual ketorolac or 1 g of IV metamizole, respectively. We evaluated pain with a visual/analog scale (VAS). Side effects were also recorded. Statistical analysis included t-test or Mann-Whitney U test and Fisher exact test or chi(2). Absolute risk reduction (ARR), odds ratio (OR), confidence interval (CI), relative risk ratio (RRR) and numbers needed to treat (NNT) were also evaluated. RESULTS: Rescue doses of analgesics were greater in patients receiving metamizole although the difference was not significant (p = 0.286). Mean VAS score was lower in the ketorolac group at 8 h after surgery, with no statistical difference (p = 0.06). ARR for severe pain score was almost 5% (OR = 1.78). Adverse effects did not show differences between groups (p = 0.642). CONCLUSIONS: Ketorolac and metamizole have comparable effects and can be safely used in ambulatory settings.

The Effects of Preemptive Analgesia of Morphine and Ketorolac on Postoperative Pain, Cortisol, O2 Saturation and Heart Rate

PURPOSE: This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, O2 saturation and heart rate for the first 24 hr after abdominal surgery. METHODS: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, O2 saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, chi-square test, repeated measures ANOVA, and Bonferroni methods. RESULTS: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and O2 saturation between the experimental group and control group. CONCLUSIONS: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn't affect blood pressure, heart rate or O2 saturation for 24 hr after abdominal surgery.

Manejo del dolor posoperatorio en la reconstrucción del ligamento cruzado anterior de la rodilla (LCA): analgesia endovenosa versus bloqueo 3-en-1 en tres modos de administración / Treatment of postoperative pain in ACL reconstruction: intravenous analgesia versus 3-in-1 block in three modes of administration

Introducción: El dolor posoperatorio producido por una reconstrucción de LCA de rodilla es moderado a severo. Objetivo: Evaluar la utilidad de la analgesia endovenosa versus el bloqueo 3-en-1 en tres modos de administración, post reconstrucción LCA. Material y método: Estudio prospectivo controlado de 124 pacientes ASA I y II que fueron divididos en cuatro grupos: grupo 1 (n= 31), 10 ml/h en IC; grupo 2 (n= 31), 5 ml/h en IC + 2.5 ml c/30 min en ARCP; grupo 3 (n= 31),5 ml c/30 min en ARCP y grupo 4 (n= 31), analgesia endovenosa. Se registró el dolor posquirúrgico entre las 2 y 48 horas mediante EVA, el consumo de morfina y el índice de satisfacción a las 48 horas. Resultados: El EVA posoperatorio promedio entre las 2 y 48 horas fue de 14 ± 3 mm en el grupo 1; 15 ± 3 mm en el grupo 2; 15 ± 4 mm en el grupo 3 y 32 ± 4 mm en el grupo 4 (p < 0.001 grupos 1,2,3 versus grupo 4). El consumo de morfina entre las 2 y 48 horas del posoperatorio fue de 6 ± 1.5 mg en los grupos 1 y 2; en el grupo 3 fue de 7.5 ± 1.5 mg y de 33 ± 3 mg en el grupo 4 (p < 0.001 grupos 1,2 y 3 versus grupo 4). En el grupo que sólo utilizó ARCP en el bloqueo 3-en-1 hubo un menor consumo de bupivacaína (p < 0.001). Conclusiones: Para el manejo del dolor posoperatorio en la reconstrucción de LCA de rodilla, la analgesia obtenida con el bloqueo 3-en-1 es superior a la administrada por vía endovenosa.

Analgesia preventiva comparando ketorolac Vrs dexketoprofeno en histerectomías abdominales / Preventive analgesia comparing ketorolac dexketoprofeno Vrs in abdominal histerectomías

Dentro de las técnicas de analgesia preventiva para tratar el dolor postoperatorio, esta incluido el uso de drogas antiinflamatorias no esteroideas (AINES). El presente estudio fue diseñado para comparar la eficacia analgésica del Ketorolaco versus Dexketoprofeno aplicado preoperatoriamente para I alivio del dolor postoperatorio. Se estudiaron 56 pacientes, ASA I-II, adultas con edades entre 27-60 años, sometidas a Histerectomía abdominal, en el Hospital Escuela Oscar Danilo Rosales Argüello, León. En el período de julio 2006 a enero 2007. Se dividieron en dos grupos de forma aleatoria, correspondiendo 28 pacientes para cada grupo. A las pacientes del grupo A, se les administró previo al acto de la inducción Ketorolac Trometemina 30 mg. por vía intravenosa. A las del grupo B, se les administro Dexketoprofeno Trometanol 50 mg por vía intravenosa, también previo al acto de la inducción anestésica. Todas las pacientes recibieron anestesia general balanceada. Durante las primeras doce horas del período postoperatorio fue medida la intensidad del dolor cada 6 horas, resultando en tres evaluaciones, la primera se realizo en sala de recuperación, correspondia a la primera hora y las segunda y tercera en sala general de ginecología (6-12 horas)...

Comparison of lidocaine vs lidocaine + ketorolac in intravenous regional anaesthesia [bier's block]

To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. An international quasi experimental study. This study was carried out in Nishtar Hospital Multan from 01/01/2006 to 30/06/2006 [6 Months]. Results: Patients were divided into two groups A and B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. We conclude that 30mg Ketorolac added to Lidocaine in IVRA increases degree of anaesthesia and also provide prolonged postop analgesia

Intravenous tramadol vs ketorolac in laparoscopic dye test

To compare the quality of analgesia and side effects of I/V tramadol with a non-steroidal anti-inflammatory drug ketorolac in patients undergoing laparoscopic dye test. A single dose, double blind, randomized clinical trial. The Day Care Surgical Unit at the Aga Khan University Hospital, Karachi. The duration was initially planned for 6 months but was completed from January 2001 to February 2002. Sixty patients coming for laparoscopic dye test were randomized by convenient sampling. Patients were divided into two groups, A and B, who received intravenous tramadol or ketorolac respectively before induction of general anaesthesia. Patients were assessed in the postanaesthesia care unit for pain using the visual analogue scale [VAS], frequency of postoperative nausea and vomiting was observed by the investigator who remained blinded to the treatment given. Any patient found to have pain score >5 was given bolus of 10 mg pethidine in titrated doses. Study was continued for 6 hours postoperatively. Pain scores were analyzed by applying Chi-square test. Students impaired t-test was used to analyze demographic data, recovery time and hospital discharge, Mann Whitney was applied to analyze VAS scores. Categorical data i.e. nausea and vomiting was analyzed by using the Chisquare test [p-value >0.05]. Study showed that tramadol is a better analgesic compared to ketorolac for patients undergoing day care gynaecological laparoscopic procedure

Analgésicos no opioides en dolor postoperatorio pediátrico / Analgesic not opioids in pediatric postoperative pain

El dolor postoperatorio es todavía subvalorado en la población pediátrica. Por otro lado, entre las publicaciones que abordan el tema del dolor postoperatorio solo un 10 por ciento de ellas incluye a la población menor de 15 años. Las alternativas terapéuticas en base a analgésicos no opiaceos es restringida en niños, ya que sólo un 20 por ciento del total de las drogas disponibles en el mercado ha probado su eficacia y seguridad en esta población. un analgésico antiguo es el acetaminofeno, acumulando la mayor cantidad de estudios. Los antinflamatorios no esteriodales (AINEs) han ganado popularidad en el manejo del dolor postoperatorio pediátrico. El objetivo de esta revision es determinar cuáles son las indicaciones y las dosis mas racionales y seguras para el tratamiento del dolor agudo en niños.

Postoperatory pain is still subvaluated in pediatric population. On the other hand, only 10 percent of publications discussing postoperatory pain subjects includes a population under age 15. Therapeutic alternatives based on nonopiate analgesics are restrained for children as only 20 percent of the total available drugs in the market has proven their efficacy and safety in children. An old analgesic is acetaminophen, which accumulates most part of studies. Nonsteroidal antinflammarory drugs (NSAI) are gaining popularity to manage postoperatory pain in children. The objective of this revision is to determine the most rational and safest indications and dosages when treating acute pain in children.

The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion

Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion.

comparison of analgesic efficacy of ketorolac and piroxicam for postoperative pain relief after cholecystectomy

A Randomized Control Trials [RCT] single blinded study was designed to evaluate the analgesic efficacy of ketorolac and compare its effectiveness with the analgesic efficacy of piroxicam for postoperative pain management after cholecystectomy at Department of Anaesthesiology and intensive care, PNS Shifa Hospital, Karachi. In this study, fifty patients who had to undergo cholecystectomy were randomized in two groups. The patients were followed for 72 hours post operatively. All the patients were operated through a standard subcostal incision [3 to 4 inches in length]. The patients were American Society of Anaesthesiology status [ASA] of I, II, of both the sexes, aged between 30 to 60 years. A balanced anaesthetic technique was used for all the patients during the conduct of procedure. First dose of both the drugs was given immediately after induction [30 mg Ketorolac I/V and 20 mg Piroxicam I/M]. Postoperatively, group I patients received injection Ketorolac 30mg I/V 8 hourly, group II patients were given injection Piroxicam 20 mg I/M once daily. If pain persistently remained above 5 on visual analogue scale [VAS], injection Pethidine 50 mg I/V p.r.n. was used as rescue analgesia for both the groups.. In group I [ketorolac group] only 5 patients [20%] required rescue analgesia whereas in group II eight patients [32%] required it. The effect of both the drugs on pulse rate, blood pressure, respiratory rate and oxygen saturation were monitored and recorded. The frequency of postoperative complication was recorded. Relevant laboratory data [bleeding time, platelets count, serum urea and electrolytes and liver function tests] was monitored. Both the drugs were found effective in controlling postoperative pain. Both drugs Ketorolac and Piroxicam provided adequate pain relief

Evaluación prospectiva de la hemorroidectomía con PPH y su comparación con otras técnicas / Prospective evaluation comparing stapled haemorrhoidectomy (PPH) with others techniques

El desarrollo de la sutura mecánica para la resolución del prolapso hemorroidario (PPH) es un novedoso procedimiento que debe ser analizado. Objetivo: evaluar la utilización de PPH con las técnicas de hemorroidectomías tradicionales utilizadas por nuestro grupo. Material y Métodos: se evaluaron en forma prospectiva, no randomizada y sucesiva 81 pacientes intervenidos por patología hemorroidaria, divididos en 3 grupos de 27 pacientes cada uno: 1) PPH; 2) anoplastía; 3) técnica semicerrada tipo Ferguson. Se incluyeron pacientes con hemorroides grado II y IV. La evaluación se dividió en 4 etapas: 1) Preoperatorio (motivo de consulta y grado de continencia). 2) Intraoperatorio (tiempo operatorio). 3) Postoperatorio inmediato (retención urinaria, fiebre, primera deposición, sangrado que requiere transfusión y/o cirugía, tiempo de internación < a 12 horas (ambulatorio) y > 12 h (c/internación). 4) Postoperatorio alejado (dolor, sangrado, continencia y grado de satisfacción). El dolor se midió por la EVA (esclava visual análoga). En anatomía patológica se buscó la existencia de fibras musculares lisas y estriadas. Resultados: 74 por ciento de las hemorroides fueron grado IV y 26 por ciento grado III. El tiempo quirúrgico fue menor para PPH que para anoplastía (p=0,02). El tiempo de internación fue estadísticamente menor en PPH (p=0,001), al igual que la incidencia de dolor (p=0,01). No hubo diferencias signifativas (ns) en cuanto al sangrado intraoperatorio ni retención urinaria. La primera deposición fue más precoz en PPH que en disección (p=0,03). Hubo mayor incidencia de fibras musculares lisas en disección y ligadura (p=0,002). No hubo diferencias en el hallazgo de fibras estriadas. En el postoperatorio mediato, el dolor fue significativamente menor para PPH, sin diferencias en la continencia. La reinserción laboral fue significativamente más precoz para PPH, con un costo 50 por ciento mayor. En el seguimiento alejado (13 meses) no hubo diferencias en el dolor residual, sangrado e incontinencia. El grado de satisfacción fue similar. Conclusión: La cirugía con PPH es segura y efectiva con una morbilidad similar a las otras técnicas evaluadas, con un significativo menor dolor postoperatorio, con un mayor costo que es compensado con la pronta reinserción laboral.