Ketorolac possesses analgesic potency against postoperative pain
Ketorolac-based analgesics demonstrate substantial local infiltration during treatment of pain in patients who have undergone breast surgery, according to a study. Locally administered ketorolac substantially reduces postoperative pain, and the effect is better than local bupivacaine.
Researchers performed a systemic review and meta-analysis on the efficacy of locally administered ketorolac-based analgesics in managing pain after breast surgery. The main study outcome was pain level, measured using a visual analogue scale (VAS) at 1 and 6 hours following surgery.
Pooled data from four randomized controlled trials, involving 255 patients, showed that VAS pain scores at 1 hour postsurgery were significantly lower among patients administered a ketorolac solution (weighted mean difference [WMD], -2.04; 95 percent CI, -3.08 to -1.00) or ketorolac-bupivacaine solution (WMD, -2.30; -4.07 to -0.54) relative to controls.
At the 6-hour time point, VAS pain scores were markedly reduced with the ketorolac-bupivacaine solution than with controls (WMD, -1.40; -2.48 to -0.32). However, at 1 hour, the ketorolac solution was superior in efficacy compared with the bupivacaine solution (WMD, -1.70; -2.81 to -0.59).
Ketorolac was the first nonsteroidal anti-inflammatory drug to be approved in the US for intravenous (IV) use in the management of postoperative pain in both adults and children. In children, the drug is used in the postoperative setting for procedures such as general, otolaryngological, urological, cardiac, trauma and orthopaedic surgeries, as well as ophthalmology procedures, and chest tube placement and removal. [J Pain Res 2010;3:67-79; Anesthesiology 2015;122:150-71; Pediatr Ann 2014;43:e169-75]
Ketorolac can be administered orally or parenterally as either IV or intramuscular. The parenteral route of administration is preferable in the immediate postoperative period, as the gastrointestinal tract may be compromised as a consequence of postoperative ileus or due to increased predisposition to nausea and vomiting after receipt of anaesthetic drugs during surgery. [Cochrane Database Syst Rev 2017;doi:10.1002/14651858.CD012294]