BALANCED ANALGESIA WITH INTRAVENOUS KETOROLAC AND PATIENT-CONTROLLED MORPHINE FOLLOWING LOWER ABDOMINAL-SURGERY

Study Objective: To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (IV) infusion of ketorolac following lower abdominal surgery. Design: Randomized, double-blind, placebo-controlled, parallel-group study. Setting: Inpatient elective gynecologic surgical patients. Patients: 60 ASA physical status I or II patients aged 18 to 70 years scheduled for elective abdominal hysterectomy. Interventions: Following standardized preparation and anesthesia, continuous IV infusions of either ketorolac or placebo were administered for 24 hours postoperatively with a patients' standardized postoperative protocol. Supplementary analgesia was administered by an IV patient-controlled analgesia (PCA) system. Measurements and Main Results: A significantly lower proportion of the patients in the ketorolac group (6%) rated their pain at 24 hours as moderate or severe compared with patients in the placebo group (34%) (p = 0.04). Mean 24-hour morphine consumption was significantly lower in the ketorolac group (43 mg; SEM 5 mg) compared with the placebo group (55 mg SEM 5 mg) (p = 0.02). There was no significant difference in the incidence of postoperative hypoxemia between the groups with respect to mean times per hour spent with oxygen saturation (SpO(2)) less than 85%, more than 85% but less than 90%, or more than 90% but less than 94%, mean hourly SpO(2), or the incidence and duration of severe hypoxemic episodes. Nausea and vomiting were the only significant adverse events, and they occurred in 30% of patients in both groups. Conclusion: Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.