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: 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

PURPOSE: An adequate pain control is one of important factors for obtaining good outcomes in the ambulatory basis of hemorrhoidectomy. There have been many methods for pain control after hemorrhoidectomy such as narcotics, various kinds of analgesics, etc. The aim of this study is to compare intraoperative internal anal sphincter injection of Ketorolac tromethamine and other two conventional methods for pain control. METHODS: A total of 56 patients with hemorrhoid grade III or IV underwent surgery between May and October 1999, and prospectively assigned to three groups in the consecutive order. The group was divided in Group 1: [Ketorolac tromethamine (Tarasyn) 60 mg intrasphincteric injection intraoperatively and 30 mg IM/prn?10 mg po/6hrs], Group 2: [No intraoperative injection and maintain pain control with Tarasyn 30 mg IM/prn/10 mg po/6hrs], and Group 3: [No intraoperative injection and maintain pain control with Pethidine (Demerol) 50 mg IM/prn and Ibuprofen 400 mg/Paracetamol 500 mg/Codeine 20 mg (Myprodol) po/8hrs]. The post operative data and pain scoring was performed on the questionnaire with Point box scale (BS-11) and Behavioral rating scale (BRS-6) each 24 hours during 5 days after surgery. RESULTS: There are 22 patients in the Group 1, 16 in the Group 2 and 18 patients in the Group 3. The median age of the Group 1 is 42.5, Group 2, 44.5 and Group 3, 45 years. The pain score on the first day after surgery in group 1 was significantly lower than group 2 (p<0.05) in the both pain scoring scale but was no differences between group 1 and 3. On the fifth day after surgery group 3 was significantly lower than both group 1 and 2 in the point box scale (p<0.05). The urinary retention rate and the day of first bowel movement after surgery show no differences among three groups (p>0.05). CONCLUSIONS: Intraoperative internal anal sphincter injection of Ketorolac tromethamine shows a better pain control than conventional methods in early postoperative period. Therefore it might be helpful for patients to go home on the day after surgery, and strong pain killer to control pain after discharge will be needed.
Anal Canal* ; Analgesics ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ibuprofen ; Ketorolac Tromethamine* ; Ketorolac* ; Meperidine ; Narcotics ; Postoperative Period ; Prospective Studies ; Surveys and Questionnaires ; Tromethamine ; Urinary Retention

PURPOSE: To assess the preemptive analgesic effect of topical NSAIDs (0.5% ketorolac tromethamine, Acular) as postoperative pain relief in patients undergoing LASEK. METHODS: A prospective, randomized, placebo-controlled, paired eye study was performed. Patients undergoing LASEK were randomized to receive 0.5% ketorolac in one eye and 0.3% ofloxacin (placebo) in the contralateral eye at 30 minutes, 20 minutes, or ten minutes prior to LASEK. Pain was assessed using a visual analog scale of 0 to 10 in each eye 6, 12, 24, 36, 48 and 72 hours after surgery. Patients were also asked to assess the levels of glare, tearing and irritation using a visual analog scale from 0 to 10. RESULTS: A total of 62 eyes from 31 patients were enrolled in the present study. The mean postoperative pain score in the NSAID group was significantly lower than that in the placebo group at postoperative hours 6 (2.35 versus 4.97), 12 (2.52 versus 5.16), and 24 (3.84 versus 4.94) (p < 0.05). The mean postoperative pain score after 36 and 48hours was also lower in the NSAID group than in the placebo group, but the differences were not statistically significant (p > 0.05). Patients reported significantly less tearing and irritation in the NSAID-administered eye compared to those in the placebo eye after LASEK (p < 0.05). CONCLUSIONS: Preemptive administration of topical NSAIDs before LASEK was effective in reducing acute postoperative pain. Preemptive analgesia with topical NSAIDs may be a valuable treatment option for controlling postoperative pain following ocular surgery.
Analgesia ; Anti-Inflammatory Agents, Non-Steroidal ; Eye ; Glare ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Ketorolac ; Ketorolac Tromethamine ; Ofloxacin ; Pain, Postoperative ; Prospective Studies

Continuous intravenous infusions of opioids can provide better pain relief than intermittent injection but may be associated with increased incidence of undesirable side effects including respiratory depression, nausea, vomiting and urinary retention. Ketorolac tromethamine is a new, nonsteroidal anti-inflammatory agent. It has significant analgesic properties without respiratory and cardiovascular depression. Mixing of opioids and ketorolac may lessen these complications without reducing analgesic effect. In six groups, we assessed the effect of postoperative pain control using morphine or fentanyl, ketorolac and droperidol, Each group consists of 100 patients. Patients in group 1, group 2, and group 3 received 2 mg of morphine via intravenous injection following the induction of anesthesia. Patients in group 1 were then continuously infused with additional 48 mg of morphine, patients in group 2 received additional 18 mg of morphine plus 120 mg of ketorolac, and patients in the group 3 were treated with the same protocol as group 2 but 2.5 mg of droperidol was added. For patients in group 4, group 5, and group 6 initially received 20 ug of fentanyl after induction of anesthesia. The rest of dose were treated with similar protocols as group I, group 2, group 3, respectively. In group 4, group 5, and group 6, morphine was substituted to 500 ug, 200 ug, and 200 ug of fentanyl, respectively. In all patients, initial dose of drug was given by bolus of intravenous injection and the rest of dose was delivered via intravenous using a Baxter Two Day Infusor or a Paragon 100. Pain scores and side effects were recorded every twelve hours for three days. No significant difference was found between the groups although pain control effect was excellent in all groups. Untoward effects were least in morphine or fentanyl-ketorolac-droperidol(group 3, group 6). It could be concluded that mixing of opioids, ketorolac and dtoperidol would be better than opioids alone.
Analgesics, Opioid ; Anesthesia ; Depression ; Droperidol* ; Fentanyl* ; Humans ; Incidence ; Infusion Pumps ; Infusions, Intravenous* ; Injections, Intravenous ; Ketorolac Tromethamine* ; Ketorolac* ; Morphine* ; Nausea ; Pain, Postoperative* ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

BACKGROUND AND OBJECTIVES: Pain control is one of the most important factors for the patients that underwent the snoring surgery. This study was performed to investigate the effectiveness of intravenous patient-controlled analgesia (PCA) for postoperative pain control after tonsillectomy with laser resection of palatopharynx. MATERIALS AND METHODS: In this double-blind randomized study, 44 patient were randomly allocated to 2 groups. In the PCA group comprising 32 patients, fentanyl citrate, ketorolac tromethamine and zofran in normal saline solution were administered by PCA equipment. In the control group comprising 12 patients, normal saline solution was given without analgesic drug by PCA equipment. Visual analogue pain score (VAS) was recorded right after surgery and 2, 4, 6, 12, 18, and 24 hours after surgery and satisfaction score was recorded just before discharge from the hospital. RESULTS: VAS was significantly higher in the control group of all time points. Overall satisfaction score was also higher in PCA group than control group. CONCLUSION: The results of this study suggest that intravenous PCA is an effective method for postoperative pain control after tonsillectomy with laser resection of palatopharynx.
Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Ketorolac Tromethamine ; Ondansetron ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Snoring ; Sodium Chloride ; Tonsillectomy*

PURPOSE: We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. MATERIALS AND METHODS: Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 μm PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn) was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. RESULTS: The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such conservative treatment as an oxygen supply. No serious side effects or complications developed from the modified intravenous analgesia injection. CONCLUSION: Modified intravenous analgesia injection is well tolerated for the pain management of uterine fibroid embolization and it is a relatively inexpensive, safe method as used in our radiologic practice.
Analgesia* ; Back Pain ; Dyspnea ; Femoral Artery ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Ketorolac Tromethamine ; Leiomyoma ; Meperidine ; Oxygen ; Pain Management ; Passive Cutaneous Anaphylaxis ; Punctures ; Uterine Artery Embolization* ; Uterine Artery* ; Uterine Neoplasms

PURPOSE: We report our experience of retroperitoneal laparoscopic nephroureterectomy (RLNUx) in 10 consecutive patients with an upper tract transitional cell carcinoma, and compare the results to those of a contemporary group of patients who underwent an open nephroureterectomy (ONUx). MATERIALS AND METHODS: The records of 10 and 17 patients who underwent RLNUx and ONUx, respectively, for an upper urinary tract transitional cell carcinoma between February 1988 and February 2004, were reviewed. RESULTS: The RLNUx, for the upper urinary tract transitional cell carcinoma, was successfully performed in all patients. Patients who underwent RLNUx had significantly less blood loss (308 versus 626.4cc, p=0.002) and consumption of ketorolac tromethamine for postoperative pain control (128.5 versus 215mg, p=0.001). However, there were no significant differences between the RLNUx and ONUx regarding the mean operative time (250 versus 222.6 minutes, p=0.081), interval to resuming oral intake (1.7 versus 1.8 days, p=0.530) and hospital stay (9.3 versus 9.8 days, p=0.300). Atelectasis and postoperative bleeding occurred in 1 RLNUx patient and atelectasis occurred in 3 ONUx patients. During average follow-ups of 19 and 25.9 months, for the RLNUx and ONUx, respectively, 1 and 2 patients had lymph node metastasis. Two patients with concomitant bladder tumors who had undergone transurethral resection at the time of the RLNUx, and two who had undergone ONUx had recurrent transitional cell carcinoma of the bladder. CONCLUSIONS: Based on our experience, we believe that RLNUx is a feasible treatment option for patients with an upper tract transitional cell carcinoma. However, long-term follow-up is necessary to confirm the efficacy for patients with transitional cell carcinomas of the renal pelvis and ureter.
Carcinoma, Transitional Cell* ; Follow-Up Studies ; Hemorrhage ; Humans ; Ketorolac Tromethamine ; Kidney Pelvis ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Neoplasm Metastasis ; Nephrectomy ; Operative Time ; Pain, Postoperative ; Pulmonary Atelectasis ; Ureter ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Tract*

PURPOSE: To compare the efficacy of a patient-controlled subacromial with intravenous analgesia following arthroscopic rotator cuff repair. MATERIALS AND METHODS: In this prospective study, 40 cases of arthroscopic rotator cuff repair who received patient-controlled analgesia by Accufuser-plus kit(R) were analyzed. There were 21 men and 19 women with a mean age of 54 years (range, 33 to 73). The patients were divided into two groups, one (20 cases in each) receiving subacromial infusion with 0.5% bupivacaine and the other receiving an intravenous infusion with fentanyl and ketorolac tromethamine. A visual analog scale (VAS) was used to record the patient's level of pain every 12 hours until the first 72 hours after surgery, and for 48 hours after the patient-controlled analgesia was stopped. RESULTS: The mean preoperative VAS during motion was 6.8 in the subacromial infusion group and 5.8 in the intravenous infusion group. The immediate postoperative VAS was 7.6 and 7.4. The subacromial infusion showed significantly better results than the intravenous infusion in 24 hours, 48 hours at rest and 48 hours during motion. After the patient-controlled analgesia was stopped, the VAS increased for the first 12 hours but decreased thereafter. Acromioplasty did not affect the results and the number of supplemental analgesic injections during patient-controlled analgesia was similar in the two groups. Three cases in the intravenous infusion group gave up the patient-controlled analgesia due to transient hypotension, nausea and vomiting. CONCLUSION: Patient-controlled analgesia using Accufuser-plus kit(R) after an arthroscopic rotator cuff repair showed that a subacromial infusion is a faster and more effective method of decreasing the level of postoperative pain than an intravenous infusion with less complications.
Analgesia ; Analgesia, Patient-Controlled* ; Bupivacaine ; Catheters* ; Female ; Fentanyl ; Humans ; Hypotension ; Infusions, Intravenous ; Injections, Intravenous* ; Ketorolac Tromethamine ; Male ; Nausea ; Pain, Postoperative ; Prospective Studies ; Rotator Cuff ; Shoulder ; Visual Analog Scale ; Vomiting