Nurse evaluation of a pain medication protocol in a selective postoperative population.

Postoperative pain in 33 patients who underwent radical prostatectomy was managed by an intramuscular nonsteroidal antiinflammatory drug protocol rather than by administration of narcotics. Patients rated their perception of pain with a visual analog scale on the first postoperative day both before and after receiving ketorolac tromethamine. The medication was effective in relieving pain after this major operation. Costs were approximately one half that of the traditional narcotic protocol used before this study.

Safety of intravenous ketorolac therapy in children and cost savings with a unit dosing system.

OBJECTIVE: To determine the incidence of side effects with the short-term use of intravenously administered ketorolac in children and the overall cost savings with a unit dosing system. STUDY DESIGN: We prospectively examined the incidence of complications arising from the intravenous administration of ketorolac to 1747 children (14,810 doses) during a 3-year, 3-month period and assessed cost savings resulting from dividing 60 mg syringes into 7.5, 15, 30, and 60 mg unit doses. Complications were recorded prospectively into a computerized database. Estimated drug costs to the pharmacy were calculated on the basis of the total numbers of each drug fraction administered, with allowance for 1O% wastage as a result of drug expiration. RESULTS: Side effects occurring with ketorolac administration were rare. Four patients (0.2%) had hypersensitivity reactions to the drug, two of them possibly on the basis of latex allergy. Two patients (O.1%) had renal complications but were subsequently found to have underlying causes that could account for their renal symptoms. One patient (0.05%) had massive gastrointestinal bleeding in the postoperative period. With fractionation of 60 mg syringes, total drug cost to the pharmacy was $34,786, rather than the $86,639 that would have been spent had a single syringe been used for each dose. CONCLUSION: Ketorolac proved safe for short-term intravenous use in children more than 1 year of age when patients with known contraindications to the use of non-steroidal antiinflammatory drugs were excluded. A considerable reduction in drug costs can be achieved with fractionation of premixed syringes into unit doses.

Evaluation of the financial impact of ketorolac tromethamine therapy in hospitalized patients.

This retrospective cohort study aimed to determine the resource utilization and cost consequences of ketorolac tromethamine in postoperative pain management in a variety of clinical circumstances. All patients were treated at LDS Hospital, Salt Lake City, Utah, a 520-bed teaching hospital. A long-term archive of clinical and financial data from a computerized hospital information system was searched for patients with specified primary International Classification of Diseases, 9th Revision, Clinical Modification discharge diagnoses treated from June 1, 1990, to July 1, 1992, who received ketorolac (n = 229). These patients were matched with cohort patients (n = 821) treated from July 1, 1989, to May 31, 1990, who did not receive ketorolac. The archive contained information on ketorolac exposure as well as concurrent drug therapy and adverse drug events that had been prospectively evaluated during hospitalization throughout the study and cohort periods. Detailed costs were available for each patient. The study examined attributable differences in lengths of stay and total costs using linear regression modeling. We found a statistically significant attributable decreased length of stay for ketorolac patients of 1.15 days. Case patients also had reduced usage of narcotic drugs (4.39 fewer doses than cohorts and 15.6 hours shorter duration of narcotics than cohorts), reduced use of antiemetic and antipruritic medications, and reduced numbers of adverse events. Linear regression modeling showed that ketorolac use was significantly related to reduced cost using inflation-adjusted dollars. We believe that ketorolac has significant cost advantages over opiate analgesics because of its narcotic-sparing effects. Advantages of ketorolac use include reduced rates of adverse drug events, reduced lengths of stay, especially for orthopedic surgery, and reduced overall hospital costs for diagnosis-related groups associated with cholecystectomy.

The use of ketorolac in lumbar spine surgery: a cost-benefit analysis.

The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.

A review of selected newer nonsteroidal anti-inflammatory drugs.

Development of nonsteroidal anti-inflammatory drugs (NSAIDs) with a goal of improved efficacy and lower toxicity has continued, resulting in the introduction of etodolac, ketorolac, nabumetone and oxaprozin on the market. Each of these agents appears to be as effective as other commonly used NSAIDs in the treatment of rheumatoid arthritis or osteoarthritis. Studies of nabumetone and etodolac show a lower incidence of serious gastrointestinal toxicity with both drugs, but additional large clinical trials are necessary to confirm these findings. Although ketorolac, which is now available in oral form, is an effective analgesic, its long-term use is limited by a high incidence of gastrointestinal toxicity. Oxaprozin is an effective, long-acting anti-inflammatory analgesic, but its comparative advantages remain undefined.

Economic assessment of ketorolac versus narcotic analgesics in postoperative pain management.

The medical records for 174 patients who underwent cholecystectomy (n = 52) or hip/knee replacement (n = 122) at four community-based medical centers were retrospectively reviewed to determine if using a nonnarcotic alternative to morphine sulfate and/or meperidine as a primary postoperative analgesic could reduce resource costs per patient. Two cohorts were constructed: 87 patients received either morphine sulfate or meperidine as the primary postoperative analgesic, and 87 patients received ketorolac. Ketorolac patients undergoing cholecystectomy were associated with lower per case costs in inpatient care (length of stay), direct nursing labor, PRN (as required) procedures, and medications relating to emesis and to gastrointestinal distress. Higher per case costs were recorded for the primary analgesic (study drug) and for supplemental pain medications. In contrast to substantial differences in the acquisition cost of ketorolac versus morphine sulfate/meperidine, the ketorolac cholecystectomy group was associated with lower overall resource costs per patient. In joint replacement procedures, however, the ketorolac group was associated with higher overall resource costs per patient, attributable primarily to a slightly higher postoperative length of stay.