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  • Title: Intramuscular ketorolac for postoperative analgesia following laparoscopic sterilisation.
    Author: Shapiro MH, Duffy BL.
    Journal: Anaesth Intensive Care; 1994 Feb; 22(1):22-4. PubMed ID: 7909209.
    Abstract:
    The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended. Ketorolac is one of the newer non-steroidal anti-inflammatory drugs (NSAIDs) that appears to have significant analgesic properties. The purpose of this study was to determine whether ketorolac would provide adequate postoperative analgesia following laparoscopic sterilization and whether it would impact the incidence of nausea and vomiting. Patients were assigned randomly, in double-blind fashion, to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of anaesthesia. All patients received fentanyl 100 mcg, a sleep-inducing dose of propofol, either atracurium or vecuronium, oxygen, nitrous oxide, isoflurane, atropine 1.2 mg, and neostigmine 2.5 mg. Surgery consisted of applying Hulka clips to the fallopian tubes. Postoperative pain was assessed using a visual analogue score (VAS) on 3 separate occasions in recovery. Patients received analgesia using a standard intravenous fentanyl, morphine or pethidine protocol if required. There was no significant difference between the 2 groups with respect to age, weight or procedure duration. Assessment of pain using the VAS slightly, but not significantly, favored the ketorolac group when patients were assessed prior to leaving the first stage recovery and prior to discharge. The worst pain scores recorded prior to discharge were similar in the 2 groups. On all occasions, there was an extremely wide range of scores in both groups. The mean opioid requirement in terms of pethidine equivalents was 23.5 mg in the ketorolac group and 35.5 mg in the saline group. This difference, however, is not statistically significant. Nausea occurred in 50% of ketorolac and 60% of saline groups, while vomiting ensued in 25% of ketorolac and 35% of saline patients. Anti-emetic use was similar in both groups (ketorolac 35%, saline 45%). A large study involving more than 186 patients would be necessary in order to demonstrate a statistically significant benefit of routinely administering ketorolac, with its potential side-effects, to all patients undergoing laparoscopic sterilization as out-patients.
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