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.

Ductus Arteriosus, Patent ; Ketorolac ; Indomethacin

OBJECTIVE: Oxycodone, a semi-synthetic thebaine derivative opioid, is commonly used for treating moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl used for treating postoperative pain with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecologic surgery. METHODS: A total of 122 patients were randomized to receive postoperative pain treatment with either oxycodone (n=62, group O) or fentanyl (n=60, group F). Patients received 7.5 mg oxycodone and 150 mcg fentanyl with ketorolac 30 mg at the end of anesthesia, and then continued with IV-PCA (conversion dose ratio, 50:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on a numerical rating scale, postoperative nausea and vomiting and other side effects, infused PCA dose, patient satisfaction, and sedation level. RESULTS: No significant differences were observed in patient satisfaction according to the analgesic used during the 48 hours postoperative period. CONCLUSION: Oxycodone showed similar efficacy for pain relief compared to fentanyl when used at a conversion dose ratio of 50:1. Therefore, oxycodone may be useful as an alternative to fentanyl for IV-PCA after laparoscopic gynecologic surgery.
Analgesia, Patient-Controlled ; Anesthesia ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Humans ; Ketorolac ; Oxycodone ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thebaine

BACKGROUND: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.
Acute Pain ; Blood Pressure ; Dihydroergotamine ; Dizziness ; Double-Blind Method ; Drug-Related Side Effects and Adverse Reactions ; Emergencies ; Emergency Service, Hospital ; Humans ; Ketamine ; Ketorolac ; Pain Management ; Renal Colic ; Urinary Calculi

BACKGROUND: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. METHODS: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. RESULTS: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. CONCLUSIONS: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.
Acetaminophen ; Adjuvants, Anesthesia ; Adult ; Analgesia ; Bupivacaine ; Catheters ; Chronic Pain ; Double-Blind Method ; Fentanyl ; Humans ; Incidence ; Ketorolac ; Magnesium Sulfate ; Magnesium ; Thoracic Surgery ; Visual Analog Scale

OBJECTIVE: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. METHODS: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. RESULTS: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. CONCLUSION: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for postoperative pain management in general surgery patients in South Korea.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Drug-Related Side Effects and Adverse Reactions ; Electronic Health Records ; Fentanyl ; Hand ; Hospitals, Teaching ; Humans ; Ketorolac* ; Korea ; Nefopam* ; Pain Management* ; Pain, Postoperative ; Paresthesia ; Passive Cutaneous Anaphylaxis ; Prescriptions ; Product Labeling ; Retrospective Studies

BACKGROUND: We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia. METHODS: One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 µg and ketorolac 180 mg in Group K, and fentanyl 600 µg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded. RESULTS: Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups. CONCLUSIONS: Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.
Analgesia, Patient-Controlled* ; Analgesics* ; Cholecystectomy, Laparoscopic ; Fentanyl ; Humans ; Incidence ; Ketorolac* ; Nefopam* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Prospective Studies* ; Respiration

BACKGROUND: We evaluated the effect of two drugs with anti-inflammatory action, dexamethasone and ketorolac, on reduction of postoperative sore throat (POST) after general anesthesia with endotracheal intubation in patients undergoing thyroidectomy. METHODS: One hundred and ninety-two female patients scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy were enrolled in this prospective study. Participants were randomly allocated to receive intravenous medication; placebo (Group C, n = 45), ketorolac 30 mg immediately before intubation (Group Kpre, n = 47), ketorolac 30 mg at the end of surgery (Group Kpost, n = 45) and dexamethasone 10 mg (Group D, n = 43). The incidence and severity of POST and hoarseness were evaluated at 1, 6 and 24 hours after surgery. RESULTS: Incidences and severities of POST at rest and during swallowing in first 6 hours after extubation were comparable among 4 groups. At 24 hours postextubation, the incidence (P = 0.002, 95% CI of proportion differences; 0.05–0.39) and severity (P = 0.008) of POST during swallowing were significantly lower in group D than in group C. Kpre and Kpost groups did not show a greater reduction in POST than group C, despite lower rescue analgesic requirement at 1 hour after extubation in group Kpre (P = 0.006; 95% CI of proportion differences; 0.07–0.38). No intergroup differences were observed in incidences of hoarseness or adverse events. CONCLUSIONS: Intravenous administration of dexamethasone 10 mg, but not ketorolac, before induction of anesthesia reduces the incidence and severity of POST during swallowing at 24 hours after thyroidectomy.
Administration, Intravenous ; Anesthesia ; Anesthesia, General ; Deglutition ; Dexamethasone* ; Female ; Hoarseness ; Humans ; Incidence* ; Intubation ; Intubation, Intratracheal ; Ketorolac* ; Pharyngitis* ; Prospective Studies* ; Thyroidectomy*

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.
Analgesia ; Analgesia, Patient-Controlled* ; Blood Urea Nitrogen ; Body Temperature ; Dizziness ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Headache ; Heart Rate ; Hematocrit ; Humans ; International Normalized Ratio ; Ketorolac* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Postoperative Care ; Pruritus ; Vital Signs ; Vomiting

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.
Analgesia ; Analgesia, Patient-Controlled* ; Blood Urea Nitrogen ; Body Temperature ; Dizziness ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Headache ; Heart Rate ; Hematocrit ; Humans ; International Normalized Ratio ; Ketorolac* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Postoperative Care ; Pruritus ; Vital Signs ; Vomiting

BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).
OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.
METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.
RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.
CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Clonazepam ; Potentially Inappropriate Medication List ; Spironolactone ; Amiodarone ; Clonidine ; Ketorolac ; Orphenadrine ; Digoxin ; Ipratropium ; Insulin ; Hydroxyzine ; Fertility ; Prescriptions ; Patients