7
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background:

          Experimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements.

          Methods:

          In a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction.

          Results:

          There were neither significant differences in VAS scores between groups ( P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point ( P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group ( P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h ( P = 0.02) and 4 h ( P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h ( P = 0.013). The respiratory rate showed no differences between groups, except at 8 h ( P = 0.017), 16 h ( P = 0.011), and 24 h ( P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate ( P > 0.05).

          Conclusions:

          Preoperative ketorolac neither showed a preemptive analgesic effect nor was it effective as an adjuvant for decreasing opioid requirements or postoperative pain in patients receiving IV analgesia with tramadol after abdominal hysterectomy.

          Related collections

          Most cited references57

          • Record: found
          • Abstract: not found
          • Article: not found

          A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain.

            Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain. The present study tested the hypothesis that patients receiving epidural fentanyl before incision would have less pain and need fewer analgesics post-operatively than patients receiving the same dose of epidural fentanyl after incision. Thirty patients (ASA physical status 2) scheduled for elective thoracic surgery through a posterolateral thoracotomy incision were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Epidural catheters were placed via the L2-L3 or L3-L4 interspaces preoperatively, and the position was confirmed with lidocaine. Group 1 received epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) before surgical incision, followed by epidural normal saline (20 ml) infused 15 min after incision. Group 2 received epidural normal saline (20 ml) before surgical incision, followed by epidural fentanyl (4 micrograms/kg, in 20 ml normal saline) infused 15 min after incision. No additional analgesics were used before or during the operation. Anesthesia was induced with thiopental (3-5 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Postoperative analgesia consisted of patient-controlled intravenous morphine. Visual analogue scale pain scores were significantly less in group 1 (2.6 +/- 0.44) than in group 2 (4.7 +/- 0.58) 6 h after surgery (P less than 0.05), by which time plasma fentanyl concentrations had decreased to subtherapeutic levels (less than 0.15 ng/ml) in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Hyperalgesia mediated by spinal glutamate or substance P receptor blocked by spinal cyclooxygenase inhibition.

              Inhibition of cyclooxygenase by nonsteroidal anti-inflammatory drugs (NSAIDs) in the periphery is commonly accepted as the primary mechanism by which these agents produce a selective attenuation of pain (analgesia). NSAIDs are now shown to exert a direct spinal action by blocking the excessive sensitivity to pain (hyperalgesia) induced by the activation of spinal glutamate and substance P receptors. These findings demonstrate that the analgesic effects of NSAIDs can be dissociated from their anti-inflammatory actions. Spinal prostanoids are thus critical for the augmented processing of pain information at the spinal level.
                Bookmark

                Author and article information

                Journal
                Saudi J Anaesth
                Saudi J Anaesth
                SJA
                Saudi Journal of Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                1658-354X
                0975-3125
                Apr-Jun 2017
                : 11
                : 2
                : 169-176
                Affiliations
                [1]Department of Cardiac and Thoracic Anesthesiology, The John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
                Author notes
                Address for correspondence: Dr. Beatriz Nistal-Nuño, Department of Cardiac and Thoracic Anesthesiology, The John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom. E-mail: nistalnunobeatriz7@ 123456gmail.com
                Article
                SJA-11-169
                10.4103/1658-354X.203011
                5389235
                28442955
                9d07d09a-f0a4-46a5-8202-75a575544197
                Copyright: © 2017 Saudi Journal of Anaesthesia

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Anesthesiology & Pain management
                abdominal hysterectomy,ketorolac,nonsteroidal anti-inflammatory drugs,postoperative pain,preemptive analgesia

                Comments

                Comment on this article