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Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery

2008; Lippincott Williams & Wilkins; Volume: 33; Issue: 12 Linguagem: Inglês

10.1097/brs.0b013e31817329bd

1528-1159

Ezequiel Cassinelli, Clayton L. Dean, Ryan Garcia, Christopher G. Furey, Henry H. Bohlman,

Pain Mechanisms and Treatments

In Brief Study Design. Prospective randomized double-blind placebo-controlled study. Objective. The objective of this study was to assess the efficacy of Ketorolac in reducing postoperative pain and morphine requirements following primary multilevel lumbar decompression surgery. Summary of Background Data. The use of opioid medications following surgical interventions can be complicated by related side effects such as respiratory depression, somnolence, urinary retention, and delayed time to oral intake. The use of Ketorolac, a potent nonopioid, nonsteroidal anti-inflammatory drug, is an attractive alternative to morphine as many of the opioid-related side effects can be avoided. Methods. After Institutional Review Board approval, 25 patients who underwent a primary multilevel lumbar decompression procedure were randomly assigned to receive either Ketorolac or placebo in a double-blinded fashion. After surgery, all patients were allowed to receive intravenous morphine on an as needed basis. Morphine requirements were then recorded immediately postoperative, at 6, 12, and at 24 hours postoperative. A patient's overall hospital course morphine requirement was also assessed. Patient postoperative pain levels were determined using the Visual Analog Pain Scale and were documented at 4, 8, 12, 16, 24, and 36 hours postoperative. Results. There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative Hemovac drain output between study groups. Morphine equivalent requirements were significantly less at all predetermined time points in addition to the overall hospital morphine requirement in patients randomized to receive Ketorolac. Visual Analog Pain Scores were significantly lower in patients randomized to receive Ketorolac immediately postoperative in addition to 4, 12, and 16 hours postoperative. There were no identifiable postoperative complications associated with the use of Ketorolac. Conclusion. Intravenous Ketorolac seems to be a safe and effective analgesic agent following multilevel lumbar decompressive laminectomy. Patients can expect lowermorphine requirements and better pain scores throughout their postoperative course. A prospective, randomized, double-blinded, placebo-controlled trial was conducted to assess the efficacy of ketorolac in the postoperative setting following a primary multilevel lumbar decompression. The group randomized to receive Ketorolac demonstrated significantly lower morphine requirements and significantly improved Visual Analog Pain scores when compared with placebo control.