Ketorolaco versus metamizol en el tratamiento del dolor posoperatorio en niños / Ketorolac versus Metamizol in the treatment of postoperative pain in children

Evaluar la efectividad de Ketorolaco y Metamizol en el tratamiento del dolor agudo posoperatorio de adenoamigdalectomías en niños de tres a seis años atendidos en el Servicio de Anestesiología en el Hospital Alberto Sabogal Sologuren durante el periodo 2012-2013. MaterialyMétodos:Estudio observacional, descriptivo, retrospectivo y transversal. La investigación incluyó 115 niños que fueron sometidos de forma electiva a adenoamigdalectomías cuyas edades estuvieron comprendidas entre los tres a seis años. Se formaron dos grupos de acuerdo al esquema analgésico que recibieron en sala de operaciones, 58 niños recibieron Metamizol y 57 niños recibieron Ketorolaco.Resultados: En el grupo que recibió Ketorolaco, 56.1%no presentaron dolor en la unidad de recuperación posanestésica según la escala de Oucher y 43.9%presentó dolor de leve a moderado (1a6). El grupo que recibió Metamizol, 19% de los niños no refirió dolor y 74.1%calificó su dolor de leve a moderado. El grado de alivio de dolor medido por escala de Oucher fue superior en los pacientes que recibieron Ketorolaco(p<0.05).Conclusión:La reducción del dolor posoperatorio en adenoamigdalectomías en niños es mayor con Ketorolaco que con Metamizol...

Evaluate the effectiveness of Ketorolac and Metamizol in the treatment of acute postoperative pain of adenotonsillectomy in children three to six years old receiving medical care in the Department of Anesthesiology at the Hospital Alberto Sabogal Sologur enduring the period 2012-2013. Material and Methods: Observational, descriptive, retrospective and cross-sectional study. The study involved 115 children who under went elective adenotonsillectomy whose ages were between tree to six years old. They are according to two groups that received analgesic therapy in the operating room, 58 childrM received Metamizol and 57 children received Ketorolac. Results: In the group receiving Ketorolac, 56.1% had no pain in the postanesthesic recovery unit according to the scale of Oucher and 43.9% had mild to moderate pain (1-6). The group that received Metamizol, 19% of children reported On and 74.1% rated their pain from mild to moderate. The degree of pain relief measured Oucher scale was higher in patients receiving Ketorolac (9 <0.05). Conclusion: Reducing postoperative pain in adenotonsillectomy in children with Ketorolac is higher than Metamizol...

Comparison of Pain-relieving Effects of Fentanyl versus Ketorolac after Eye Amputation Surgery

PURPOSE: To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery. METHODS: Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 microg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed. RESULTS: The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups). CONCLUSIONS: Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.

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.

Calotropis procera -induced keratitis.

Calotropis procera produces copious amounts of latex, which has been shown to possess several pharmacological properities. Its local application produces intense inflammatory response. In the 10 cases of Calotropis procera -induced keratitis reported here, the clinical picture showed corneal edema with striate keratopathy without any evidence of intraocular inflammation. The inflammation was reversed by the local application of steroid drops.

Is Intravenous Patient Controlled Analgesia Enough for Pain Control in Patients Who Underwent Thoracoscopy?

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.

Estudo comparativo entre cetorolaco e cetoprofeno no controle da dor pós-operatória de uvulopalatofaringoplastia / A comparative study between Ketorolac and Ketoprofen in postoperative pain after uvulopalatopharyngoplasty

A dor no pós-operatório imediato apresenta-se como um grave problema, requerendo do médico uma adequada assistência. Na Otorrinolaringologia, merece atenção especial a dor após uvulopalatofaringoplastia (UPFP). OBJETIVO: Comparar a eficácia na analgesia pós-operatória do cetorolaco com o cetoprofeno em UPFP. PACIENTES E MÉTODOS: Estudo prospectivo, randomizado, duplo-cego com 24 pacientes submetidos à UPFP, divididos em 2 grupos, sendo que 14 receberam cetorolaco e 10 cetoprofeno. Avaliação da intensidade da dor através de escala visual analógica e necessidade do uso associado de opióide (tramadol). RESULTADOS: Dos 14 pacientes que receberam cetorolaco, apenas 3 (21 por cento) necessitaram uso complementar de opióide, enquanto que 7 (70 por cento) do grupo do cetoprofeno o fizeram. Após 12 horas de cirurgia, houve um predomínio de 71 por cento dos pacientes que receberam cetorolaco, com dor leve ou até ausência desta, enquanto 70 por cento dos do cetoprofeno referiram dor moderada ou incômoda. Após 24 horas de cirurgia, 60 por cento dos pacientes que fizeram uso de cetoprofeno referiam dor moderada a incômoda, ao passo que 86 por cento dos do cetorolaco referiram dor leve à ausência. CONCLUSÃO: Conclui-se que o cetorolaco é mais eficaz em relação ao cetoprofeno no tratamento da dor pós-operatória imediata de UPFP, pois houve dor de menor intensidade e menor uso de opióide.

Postoperative pain is a serious problem, requiring an appropriate response from the medical doctor. In otolaryngology special attention is needed after uvulopalatopharyngoplasty (UP3). AIM: To compare the efficacy of postoperative analgesia using ketorolac and ketoprofen after UP3. PATIENTS AND METHODS: A prospective, randomized, double-blind study was made of 24 patients that were divided into 2 groups (14 received ketorolac and 10 received ketoprofen). Pain intensity was based on an analog visual scale and the need for opioids (tramadol). RESULTS: Of the 13 patients that received ketorolac, 3 (21 percent) required opioids; 7 of 10 (70 percent) patients in ketoprofen group used opioids. 12 hours after surgery, 71 percent of the patients that received ketorolac had mild or absence of pain. 70 percent of the ketoprofen users reported moderate to significant pain. 24 hours after surgery, 60 percent of the patients using ketoprofen reported moderate to significant pain, while 86 percent of the ketorolac users reported mild or absence of pain. CONCLUSION: We concluded that ketorolac is more effective compared to ketoprofen in the treatment of immediate postoperative pain after UP3, as patients using ketorolac had less pain and used opioids to a lesser degree.

[Co-analgesic effect of ketorolac after thoracic surgery]

Thoracotomies are painful surgical procedures and adequate pain relief is associated with improved respiratory function and fewer respiratory complications. After thoracotomy for lung resection, patients received morphine-based patient-controlled analgesia [PCA]. Three groups were propectively and randomized investigated: patients receiving preemptive ketorolac, those given postoperative ketorolac and controls. No differences among groups were found for demographic data, anesthesia and surgery durations, or for the amounts of anesthesia drugs administered. The blood loses were also comparable: 565 +/- 374 ml for the preemptive ketorolac group, 749 +/- 491 ml for the postoperative ketorolac group and 674 +/- 323 ml for the controls. At 48 h after surgery, compared to control, morphine consumption was 36% lower for the preemptive ketorolac group and 17% lower for postoperative ketorolac group [p< 0.05]. No statistically significant differences were observed for pulmonary function tests. These results suggest that non-steroidal anti-inflammatory drugs can reduce the opioid requirements after thoracic surgery but do not improvement lung function

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.

Role of cyclooxygenase-2 in lipopolysaccharide-induced hyperalgesia in formalin test.

Lipopolysaccharide (LPS)-induced hyperalgesia and the role of cyclooxygenase (COX) isoforms in acute and chronic nociceptive assays have been well established. However, the role of COX isoforms in LPS-induced hyperalgesia in the formalin test is not clear. Thus, the present study was undertaken to characterize the time course of formalin-induced nociceptive response in LPS-pretreated mice and to investigate possible effects of COX inhibitors to address the potential role of COX isoforms in LPS-induced hyperalgesia in the formalin test. All the animals showed typical biphasic response to formalin challenge. At 0 hr (immediately) and 4 hr after LPS pretreatment, animals did not show any alteration in formalin-induced tonic pain. However, 12 and 16 hr after LPS pretreatment, there was a significant increase in the late phase of formalin-induced nocifensive response as compared to control mice. Treatment with intravenously administered ketorolac (a nonselective COX inhibitor) significantly and dose-dependently inhibited the late phase of formalin-induced nociceptive behaviour in saline and LPS-pretreated mice. In contrast, parecoxib (prodrug of valdecoxib, a selective COX-2 inhibitor) or dexamethasone (COX-2 transcription inhibitor), when administered intravenously or intraperitoneally, respectively, did not show antinociceptive effect in the formalin test in saline-pretreated mice. However, both the agents significantly and dose-dependently decreased the late phase nociceptive behaviour of the formalin test in LPS-pretreated mice to the level of the animals that received saline pretreatment. These results suggest that induction of COX-2 by proinflammatory mediators and subsequent release of prostaglandins could be responsible for LPS enhancement of formalin-induced nocifensive behaviour and supports an important role of COX-2 in LPS-induced hyperalgesia in the formalin test.

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

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.

Quiste pilonidal. Técnica de Buie / Pilonidal cyst. Buie's technique

Introducción: la técnica de marsupialización tiene múltiples ventajas para el tratamiento del quiste pilonidal. El objetivo es analizar la experiencia en el tratamiento quirúrgico de esta patología con la técnica de Buie. Diseño: evaluación retrospectiva. Método: se evaluaron 31 pacientes portadores de quistes pilonidales operados con la técnica de marsupialización, 26 hombres y 5 mujeres con un promedio de edad de 28,4 años (rango 15 a 49 años). Resultados: se observó en mayor proporción en individuos jóvenes del sexo masculino. La técnica de Buie requirió una breve hospitalización, con mínimo dolor postoperatorio, bajo índice de morbilidad y rápida reinserción laboral. Conclusiones: este procedimiento es simple, con bajo índice de complicaciones y es un excelente método para el tratamiento quirúrgico de la enfermedad pilonidal no complicada.

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.

A double-blind, randomized study comparing postoperative pain management using epidural ropivacaine with intravenous ketorolac or intravenous ketorolac alone following transabdominal hysterectomy.

OBJECTIVE: The aim of this study is to compare the effect on postoperative pain of epidural ropivacaine in combination with intravenous ketorolac with intravenous ketorolac alone following transabdominal hysterectomy. DESIGN: A multi-center, randomized, double-blind study was conducted in Thailand and the Philippines to assess postoperative pain management in 107 patients given ketorolac alone or in combination with epidural ropivacaine following transabdominal hysterectomy. Pain score was assessed using a 100-mm visual analogue pain scale (VAS). RESULTS: The VAS scores for pain on coughing and at rest were significantly better in the ropivacaine group. The number of patients who asked for morphine in addition was higher in the ketorolac group compared to the ropivacaine + ketorolac group. The time taken to carry out the first three ambulatory steps was similar for both the two treatment groups. A higher degree of motor block was observed in the ropivacaine group over time. The adverse events observed were similar in both groups. CONCLUSION: We demonstrated that epidural infusion of ropivacaine in addition with intravenous ketorolac gave superior pain relief at rest and on coughing in patients undergoing transabdominal hysterectomy when compared to the group receiving intravenous ketorolac alone.

Analgesia en procedimientos fotorrefractivos. Una comparación entre gotas, escudos de colágeno y lentes de contacto desechables / Analgesy in photorefractive procedure. A comparison betwen drops, collagen shields and disposable contac lens

Propósito: Comparar los diferentes métodos de uso del Ketorolac para obtener analgesia postoperatoria en pacientes operados con el procedimiento de PRK (por sus siglas en inglés) para miopía. Materiales y métodos: En este estudio prospectivo se incluyó a un grupo de 45 pacientes de forma aleatoria en tres grupos de tratamiento: Grupo A: Gotas cada 2 horas y parche. Grupo B: Lente de contacto blando impregnado. Grupo C: Escudos de colágeno empapados. Se diseñó un formulario de evaluación y se pidió a los pacientes que contestaran por sí mismos en relación con sus sintomatologías en intervalos de 4, 8, 12, 24 y 48 horas. Se realizó evaluación por el observador a las 24 y 48 horas. Resultados: Para todos los grupos el intervalo donde se experimentó el nivel de dolor más alto fue entre las 8 y las 12 horas. Unicamente en el grupo A, el nivel de dolor medio fue severo. Los grupos B y C mostraron dolor medio y moderado respectivamente. Otras molestias fueron experimentadas, principalmente en los grupos A y C, de los cuales el principal fue sensación de cuerpo extraño. Conclusiones: Los lentes de contacto (escudos de colágeno o desechables) empapados con ketorolac y con gotas cada dos horas con el mismo analgésico, parece ser el mejor tratamiento para controlar el dolor postoperatorio en pacientes a quienes se les practicó queratectomía fotorrefractiva (PRK).