EFFECTS OF KETOROLAC ON POSTOPERATIVE ANALGESIA AND VENTILATORY FUNCTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Ketorolac, a nonsteroidal anti-inflammatory drug, is alleged to produce postoperative analgesia without opioid-related side effects. Patients undergoing laparoscopic cholecystectomy were assigned randomly to receive either ketorolac or a placebo (saline) according to a double-blind protocol. Preoperative (baseline) pulmonary function was evaluated using a Respiradyne II monitor. Patients received midazolam, 2 mg, and 2 mL of either ketorolac, 60 mg (n = 31), or saline (n = 29), 20-40 min before surgery. Anesthesia consisted of thiopental, 4-5 mg/kg, and vecuronium, 0.1 mg/kg, for induction, and isoflurane, 0.5%-2.0%, with 67% nitrous oxide in oxygen for maintenance. A second 2-mL dose of the same study medication (ketorolac, 60 mg, or saline) was administered 4 h after the initial dose. Postoperatively, 66% of patients in the saline group complained of pain requiring treatment with fentanyl compared to 32% in the ketorolac group (P < 0.05). There were no significant differences between the two groups with respect to postoperative sedation, anxiety, pain, or nausea visual analog scores. Compared to the preoperative values, significant decreases in pulmonary function tests were noted in both groups at 4 h after the operation and the following morning (P < 0.01). In the ketorolac group, only values of forced expiratory volume at 1 s and forced expiratory flow at 25%-75% of the forced vital capacity at 4 h after the operation were significantly higher than those in the saline group (P < 0.05). Incidences of nausea (45% vs 52%) and vomiting (10% vs 10%) were similar in both groups. In conclusion, ketorolac decreased the postoperative requirement for opioid analgesic medication. However, the use of ketorolac failed to decrease postoperative emesis or ventilatory impairment after laparoscopic cholecystectomy.