Intravenous ketorolac as an adjunct to patient controlled analgesia (PCA) for management of postgynecologic surgical pain

Abstract

STUDY OBJECTIVE: To determine whether intravenous (IV) doses of ketorolac tromethamine provide safe and effective augmentation of postsurgical analgesia for patients using IV patient-controlled analgesia (PCA) with morphine. DESIGN: Randomized, double-blind, placebo-controlled, dose-response evaluation. SETTING: Patient care unit at a university medical center. PATIENTS: 62 ASA physical status I-III females recovering from intra-abdominal gynecologic surgery with general anesthesia who requested postoperative PCA. INTERVENTIONS: Following initial pain assessment in the recovery room, patients were randomized to receive either IV saline (placebo) followed by IV saline every 6 hours (Group 1); IV ketorolac 30 mg loading dose followed by IV ketorolac 15 mg every 6 hours (Group 2); or IV ketorolac 60 mg loading dose followed by IV ketorolac 30 mg every 6 hours (Group 3). All patients were provided IV PCA, which was programmed to provide 1.2 mg of morphine with a 6-minute lockout interval. MEASUREMENTS AND MAIN RESULTS: Visual analog scale (VAS) resting pain and satisfaction scores were measured every 2 to 12 hours. Cumulative PCA with morphine and the frequency and severity of side effects also were assessed. IV ketorolac showed no clinically significant side effects. Group 2 patients experienced significant reductions in VAS resting pain scores (p < 0.05), and a trend toward decreased morphine self-administration in both active groups was noted. Group 2 and Group 3 patients reported greater satisfaction with postsurgical analgesia than Group 1 patients. (p < 0.05). CONCLUSIONS: IV ketorolac used as an analgesic adjunct provided safe and effective augmentation of PCA with morphine in patients recovering from intra-abdominal gynecologic surgery.