BACKGROUND: Both ketorolac and propacetamol are used postoperatively to control mild to moderate pain. This study compared the analgesic efficacy of ketorolac and propacetamol delivered either preoperatively or postoperatively, and assessed the preemptive analgesic effect of ketorolac and propacetamol for adenotonsillectomy. METHODS: One hundred and two pediatric patients were divided randomly into four groups. The K1 and P1 groups received ketorolac 1 mg/kg or propacetamol 30 mg/kg after induction, respectively, whereas the K2 and P2 groups received each drug at the end of the operation, respectively. After adenotonsillectomy, we measured the NRS (Numerical Rating Scale), FPS (Faces Pain Scale) and OPS (Objective Pain scale) at 15, 30 and 60 min after arriving at the postanesthesia care unit. RESULTS: There were no significant differences in the NRS, FPS and OPS between K1 and K2 and between P1 and P2 for 60 min after operation at the postanesthesia care unit. CONCLUSIONS: These results suggest that both ketorolac (1 mg/kg) and propacetamol (30 mg/kg) have no preemptive analgesic effects during 1 hour after adenotonsillectomy.
Acetaminophen ; Child ; Humans ; Ketorolac

Objective: This study compared the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification. Methods: This is a prospective, randomized, double-masked comparative study involving adult cataract patients given topical NSAIDs (ketorolac or nepafenac) or balanced salt solution (control) prior to phacoemulsification and capsular bag intraocular-lens (IOL) implantation at a tertiary hospital. Horizontal and vertical diameters of pupil were measured at different stages of cataract surgery and the mean values were compared across the three groups. Results: A total of 47 eyes of 44 cataract surgery patients, 13 males and 34 females, with a mean age of 66.04 ± 8.87 years, were included in the study. The mean horizontal and vertical diameters of the three groups were similar at the start of surgery. Significant differences were seen after IOL implantation, with the nepafenac group having the largest mean diameters in both horizontal (p = 0.012) and vertical (p = 0.012) pupil measurements. Conclusion Topical nepafenac has been shown to be a more effective inhibitor of miosis during phacoemulsification and provides a more stable mydriatic effect throughout the surgical procedure compared to topical ketorolac and placebo.
Cataract ; Phacoemulsification ; Mydriasis ; Ketorolac

Background. Indomethacin has been the gold standard for the closure of patent ductus arteriosus (PDA). Still, the availability of the intravenous (IV) form has been a big issue precluding its use in the Philippines. IV ketorolac is another non-steroidal anti-inflammatory drug (NSAID) that is cheaper and more available in our country and used for post-cardiac surgery pain management among neonates.

Objectives. To compare the efficacy of ketorolac versus indomethacin in the closure of patent ductus arteriosus among preterm infants.

Methods. We conducted a randomized controlled, double-blind, crossover design, non-inferiority trial on the use of iindomethacin versus ketorolac among preterm infants with PDA. We enrolled preterm infants at 5-12 days postnatal life, diagnosed with PDA by echocardiography at the Philippine General Hospital (PGH). We excluded infants with upper gastrointestinal bleeding, renal failure, birthweight < 500 grams, septic shock, and lethal anomalies. Patients were randomly allocated between two treatment groups (indomethacin versus ketorolac). The primary outcome measure was PDA closure measured after the treatment course. Adverse events like oliguria and bleeding were recorded.

Results. A total of 27 preterm infants were randomly assigned to the indomethacin (0.2 mg/kg/dose) and ketorolac (0.6 mg/kg/dose) group. Ketorolac has a 60% success rate for PDA closure (9/15) compared to indomethacin 41.67% (5/12) (p=0.154). No renal insufficiency and bleeding diathesis were noted. Five patients died in the study, four in the group initially allocated in ketorolac and one in indomethacin. Causes of death were late-onset sepsis, bronchopulmonary dysplasia, and congenital adrenal hyperplasia.

Conclusion. The success rate of PDA closure between IV ketorolac and IV indomethacin was not significantly different. There was neither oliguria nor bleeding observed in both groups.

BACKGROUND: A majority of patients undergoing chemical peeling complain of pain severe enough to disturb the process of the peeling. However, there has been few controlled studies on pain control during chemical peeling. OBJECTIVES: We evaluated the efficacy and safety of pretreatment with intramuscular ketorolac (Tarasyn, 30 mg) and oral diazepam(Valium, 5 mg) in comparison with control and diazepam groups, and compared the sensitivity of pain between two sexes. METHODS: The patients were randomly assigned to one of three groups; control, diazepam, and ketorolac plus diazepam groups. Pain intensity was assessed 5 times at every ten minutes from the beginning of the peeling using visual analog scale(VAS). RESULTS: At every 10 minutes of pain assessment, ketorolac plus diazepam group recorded the lowest VAS among the three groups. Except at the first 10 minutes, nificant. There was no significant difference in the pain intensity between the sexes at all five times. After application of Jessner`s solution, there was significant increase of VAS in all groups. CONCLUSION: The ketorolac pretreatment is a safe and effective modality of pain relief prior to chemical peeling without the adverse reactions.
Diazepam ; Humans ; Ketorolac* ; Pain Measurement ; Premedication*

BACKGROUND: In patient-controlled analgesia (PCA), ketorolac tromethamine has been mixed with nalbuphine HCL in the same PCA balloon or syringe. The compatibility of mixed drugs is an important factor in determining the effects of the administered drugs, so we examined the compatibility of the mixed solution of the both drugs in various dilutions. METHODS: Ketorolac tromethamine (K1, 3, 7, 19 group; n = 10/group) or nalbuphine HCl (N1, 3, 7, 19 group; n = 10/group) was diluted 1: 1, 3, 7, or 19 with normal saline and then the other drug was added. The presence of precipitates, turbidity by visual and spectrophotometric methods, and the pH of the mixed solutions were evaluated 0, 1, 6, 12 and 24 hours later. RESULTS: Precipitates were observed in all studied solutions except in solutions of nalbuphine HCl diluted 1 : 19 with normal saline plus ketorolac tromethamine at the observed intervals. Turbid changes were observed in N1, 3, K1, 3, and 7, but significantly decreased from 6 hours after mixing. The pH of the K groups were significantly lower than those of the N groups. CONCLUSIONS: The mixed solutions of ketorolac tromethamine with nalbuphine HCl were visually incompatible in almost all studied cases, so careful considerations are needed in mixing ketorolac tromethamine with nalbuphine HCl.
Analgesia, Patient-Controlled ; Hydrogen-Ion Concentration ; Ketorolac Tromethamine* ; Ketorolac* ; Nalbuphine* ; Passive Cutaneous Anaphylaxis ; Syringes

BACKGROUND: In spite of frequent nasal surgery, the importance of preoperative medication has not been examined carefully(CAREFULLY). OBJECTIVE: To identify the effect of premedication, we investigated the effect of premedication on postoperative pain in nasal surgery under local anesthesia. MATERIALS AND METHOD: We studied 120 cases, composed of 60 cases of unilateral sinus surgery and 60 cases of septoplasty. The patients were divided into four groups. We analysed 4 groups each consisted of 30 patients(N=120). The first group consisted of patients who received atropine preoperatively. The second group received atropine and ketolorac tromethamine. The third group received atopine and diazepam. The fourth group received atropine, ketorolac trimethamine and atropine. To evaluate the postoperative pain, we made the protocol listed according to Verbal Rating Pain Scores(VRP), Visual Analogue Pain Scores(VAS), -2, 4, 6, 12, 24 and 48 hours- and a global postoperative pain using the VAS. RESULTS: In septoplasty group, pain-relief effects showed postoperative pain of ketorolac tromethamine during postoperative 6-hours in the second & fourth groups. In sinus surgery group, Ketorolac tromethamine was effective on postoperative pain at postoperative 2-hour. CONCLUSION: We concluded that preoperative ketorolac tromethamine was effctive on septoplasty group than sinus surgery group.
Anesthesia, Local ; Atropine ; Diazepam ; Humans ; Ketorolac ; Ketorolac Tromethamine ; Nasal Surgical Procedures* ; Pain, Postoperative* ; Premedication* ; Tromethamine

BACKGROUND: Pain management in the terminal stage of advanced cancer is often complicated by opioid-related bowel syndrome and other problems. This study was conducted to investigate the safety and efficacy of ketorolac as an adjunctive analgesic in cancer pain management. METHODS: 10 acutely ill cancer patients suffering from pain, complications of advanced disease, and opioid side effects were included. Except one acute leukemia, all of the patients had metastatic solid tumors. Pain complaints consisted of visceral, somatic and opioid bowel syndrome. They were treated with intravenous morphine patient-controlled analgesia infused with a repeated ketorolac bolus dosing. Demographic data, cancer diagnosis, change of pre- and post-treatment morphine infusion rates, and days until pain control or relief of opioid bowel syndrome were evaluated. RESULTS: Excellent pain relief with improvement of opioid bowel syndrome was achieved in a majority of cases. Ketorolac showed good morphine sparing effects. None of the patients reported gastrointestinal side effects. CONCLUSION: Ketorolac appeared to be well-tolerated in the clinical dose range and for short-term use in acutely-ill terminal cancer pain patients. It also seems to be very effective in relieving opioid-related bowel syndromes.
Analgesia, Patient-Controlled ; Diagnosis ; Humans ; Ketorolac* ; Leukemia ; Morphine ; Pain Management*

PURPOSE: We evaluated the effectiveness of tamsulosin on the expectant treatment for the patients suffering with lower ureteral stones. MATERIALS AND METHODS: A total of 67 patients with stones less than 5mm that were located in the lower ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=32) received 20mg caroverine (a spasmolytic drug) orally three time a day. Group 2 (n=35) received 0.2mg tamsulosin orally one time a day. The treatment was continued until expulsion of stone or to a maximum of 28 days. All patients were allowed 30mg ketorolac trimethamine intramuscular injections on demand. We compared the two groups for stone size, the expulsion rate, the time to expulsion and use of analgesics. RESULTS: The average stone size was 4.3+/-0.61mm for group 1 and 4.4+/-0.51mm for group 2. No statistical difference between two groups was found for stone size, age and sexual distribution. The expulsion rate was significantly higher in group 2 (82.8%), compared with group 1 (53.1%) (p=0.002). The mean expulsion time was 8.3 days for group 1 and 4.6 days for group 2 (p<0.0001). The average number of intramuscular analgesic injections was 3.9 for group 1 and 1.1 for group 2 (p<0.0001). CONCLUSIONS: Tamsulosin was proved to be effective and safe, as demonstrated by the increased stone expulsion rate, the decreased expulsion time and the reduced use of pain control in the expectant treatment of the lower ureter stones.
Analgesics ; Humans ; Injections, Intramuscular ; Ketorolac ; Ureter* ; Urinary Calculi

PURPOSE: We evaluates if the administration of tamsulosin increases the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the patients with upper ureteral stones and if this decreased the use of analgesic drugs after the procedure. MATERIALS AND METHODS: A total of 45 patients with stones 6-12mm in size that were located in the upper ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=23) received 3 times a day oral treatment of 20mg caroverine (a spasmolytic drug). Group 2 (n=22) received one time a day oral therapy of 0.2mg tamsulosin. All the patients received oral treatment for 14 days. Both groups of patients were allowed to use 30mg ketorolac trimethamine intramuscular injections on demand. The endpoint of the study was the stone expulsion rate, the use of analgesics and the drug adverse effects during treatment. RESULTS: The average stone size was 7.9+/-2.79mm for group 1 and 8.2+/-3.14mm for group 2. No statistical difference between the two groups was found for the stone size, age and gender distribution. The expulsion rate was significantly higher in group 2 (90.9%) compared with group 1 (65.2%) (p=0.038). The average number of pain control injections was 0.78 for group 1 and 0.23 for group 2, and there was a statistically significant difference between the two groups (p=0.042). CONCLUSIONS: The use of tamsulosin proved to be effective and safe, as demonstrated by the increased stone expulsion rate and the lesser need for pain control than that when using just a spasmolytic drug for ESWL of upper ureter stones.
Analgesics ; Humans ; Injections, Intramuscular ; Ketorolac ; Lithotripsy* ; Shock* ; Ureter* ; Urinary Calculi

BACKGROUND AND OBJECTIVES: This study was to investigate the effect of preoperative administration of midazolam and ketorolac for postoperative pain and antegrade amnesia in septoplasty under local anesthesia. MATERIALS AND METHODS: We studied 40 patients who underwent septoplasty under local anesthesia. The patients were divided into four groups, each consisting 10 patients (N=40). The groups received different treatment, with the first group receiving ketorolac, the second group ketorolac and diazepam, and the third group ketorolac and midazolam. The fourth group received midazolam only. Postoperative pain was evaluated according to Verbal Rating Pain Scores (VRP), and Visual Analogue Pain Scores (VAS) at 2, 4, 6, 12, 24 and 48 hours after operation. Antegrade amnesia was evaluated also. RESULTS: Postoperative pain was decreased at 6, 12, 24 hours in the third and fourth group. Antegrade amnesia was noted in the third and fourth group. The third group showed strong antegrade amnesia. CONCLUSION: Preoperative administration of ketorolac and midazolam were effective for postoperative pain and antegrade amnesia in septoplasty.
Amnesia ; Anesthesia, Local ; Diazepam ; Humans ; Ketorolac* ; Midazolam* ; Pain, Postoperative