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*

PURPOSE: To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS: A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS: Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION: Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.
Aged ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/pharmacology ; Benzophenones/*administration & dosage/pharmacology ; Bromobenzenes/*administration & dosage/pharmacology ; *Cataract ; *Cataract Extraction ; Female ; Humans ; Inflammation/prevention & control ; Ketorolac/*administration & dosage/pharmacology ; Lens Implantation, Intraocular ; Macular Edema/*prevention & control ; Male ; Middle Aged ; Miosis/*prevention & control ; Phacoemulsification ; Postoperative Complications/drug therapy ; Postoperative Period ; Premedication ; Treatment Outcome

BACKGROUND: Spontaneous adverse drug reaction (ADR) reporting data has been used for safety of post-market drug surveillance. A system has been required that is able to detect signals associated with drugs by analyzing the collected ADR data. METHODS: We developed the web-based automated analysis system (ADR-detector). We used the data which reported ADR spontaneously between March 2009 and December 2010 to Korean Food and Drug Administration. We used 3 statistical indicators for evaluating ADR signals: proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). The ADR reports which were detected as significant signals based on the indicators have been reviewed. RESULTS: Among 153,774 reports, 9,955 cases were related to 4 analgesics which were most frequently reported analgesic drugs during the study period. The numbers of ADR reports associated with each drug are as follow: 5,623 reports in tramadol (56.5 %), 1,720 reports in fentanyl (17.3 %), 1,463 reports in tramadol-combination (14.7 %), and 1,149 reports in ketorolac (11.5 %). Top 5 ADR were nausea (3,351 reports - 33.7 %), vomiting (1,755 reports - 17.6 %), dizziness (1,130 - 11.4 %), rash (412 reports - 4.1 %), and pruritus (354 reports - 3.6 %). 6,674 ADR reports were significant based on PRR and ROR, and 336 reports were significant based on IC. CONCLUSION: By using the automated analysis system, not only statisticians but also general researchers are able to analyze ADR signals in real-time. Also ADR-detector would provide rapid review and cross-check of ADR.
Analgesics ; Data Mining ; Dizziness ; Drug Toxicity ; Exanthema ; Fentanyl ; Ketorolac ; Nausea ; Odds Ratio ; Pruritus ; Tramadol ; United States Food and Drug Administration ; Vomiting

PURPOSE: This study investigated the preemptive analgesic effects of Morphine and Ketorolac on postoperative pain, cortisol, O2 saturation and heart rate for the first 24 hr after abdominal surgery. METHODS: Data collection was performed from April 1 to September 30, 2006. Forty patients undergoing a gastrectomy under general anesthesia were randomly allocated to the experimental or control group. The experimental group (20 patients) was administered Morphine and Ketorolac approximately 1 hr prior to skin incision, but the control group (20 patients) was administered Morphine and Ketorolac at peritoneum closure through a patient-controlled analgesia (PCA) pump. Postoperative pain, blood pressure, heart rate, cortisol, O2 saturation, frequency of the PCA button pressed and doses of additional analgesics were observed through post operative 24 hr. Collected data was analyzed using t-test, chi-square test, repeated measures ANOVA, and Bonferroni methods. RESULTS: Postoperative pain, cortisol, the frequency of PCA button pressed, and dose of additional analgesics of the experimental group were significantly lower than the control group. There were no statistical differences in blood pressure, heart rate and O2 saturation between the experimental group and control group. CONCLUSIONS: We concluded that administration of morphine and ketorolac at 1 hr prior to skin incision resulted in decreasing postoperative pain, but it didn't affect blood pressure, heart rate or O2 saturation for 24 hr after abdominal surgery.
Aged ; Analgesics/*administration & dosage ; Blood Pressure ; Female ; Heart Rate ; Humans ; Hydrocortisone/analysis ; Injections, Intravenous ; Ketorolac/*administration & dosage ; Male ; Middle Aged ; Morphine/*administration & dosage ; Oximetry ; Pain Measurement ; Pain, Postoperative/*prevention & control

Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion.
Adult ; Aged ; *Analgesia, Patient-Controlled ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/*adverse ; Case-Control Studies ; Drug Therapy, Combination ; Female ; Fentanyl/administration & dosage/therapeutic use ; Humans ; Injections, Intravenous ; Ketorolac/*administration & dosage/*adverse effects/therapeutic use ; Male ; Middle Aged ; Postoperative Care/*adverse effects ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; *Spinal Fusion/standards ; Treatment Outcome

BACKGROUND: Postoperative pain control in children is an important problem for management but it was treated negligently. In the past, the pain was undertreated in children, even more in infant. In recent years, the importance of the pain control in children was emphasized but not enough, yet. This study was designed to evaluate the propriety of intraoperative intravenous medication technique and effectiveness of the fentanyl, ketorolac and ketamine for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Eighty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV were received intravenous fentanyl 1microgram/kg, ketorolac 1 mg/kg and ketamine 1 mg/kg respectively. Fentanyl and ketolorac were injected intravenously during the induction of anesthesia and ketamine was injected at the entrance of operating room. Emergence time and the degree of pain was evaluated. RESULTS: Our result showed that group II and group III had a lower pain score than that of the control group at the 5 min, 10 min, 20 min and 30 min in the recovery room (P <0.05), but no significant differences were found between the group I and group IV. The time interval from the end of operation to extubation was prolonged in the group II compared to the control group (P <0.05). But no significant differences were found between the three groups. CONCLUSIONS: We suggest that intravenous administration of analgesics has the propriety of the control of postinguinal herniorraphy pain in children. Intravenous administration of fentanyl 1microgram/kg and ketorolac 1 mg/kg during induction would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.
Administration, Intravenous ; Analgesics ; Anesthesia ; Anesthesia, General ; Child* ; Fentanyl ; Herniorrhaphy* ; Humans ; Infant ; Ketamine ; Ketorolac ; Operating Rooms ; Pain, Postoperative ; Recovery Room

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

BACKGROUND: Postoperative pain is the principal acute pain and many trials have been done for it. The preemptive analgesic method is one of the trials and nonsteroidal antiinflammatory drugs (NSAIDs) have been under study to reduce the side effects of opioids and to gain some other advantages, and many positive results have been reported. The author therefore planned this study to evaluate whether or not NSAIDs could have a preemptive effect, to observe any difference in effect with increasing dose, and to identify any advantage to patients under preemptive analgesia. METHODS: Seventy-five patients undergoing open cholecystectomy or choledochocystostomy were randomly allocated into three groups, group K0, K30 and K60. In group K0 (n = 25), patients were given no medication before operation. In groups K30 and K60, patients were given ketorolac 30 mg and 60 mg by intravenous route at 15 minutes before operation respectively. After operation, one observer who didn't know which group the patients were allocated to recorded patients' pain score (visual analogus scale; VAS and Prince-Henry score; PHS), side effects and satisfactory score at postpoperative 0, 1, 6, 12, 24 and 48 hours. For VAS > 50 or PHS > 3, morphine 2.5 mg was given by intravenous route and pain score was reestimated after 10 minutes and this was repeated until VAS < 50 and PHS < 3. RESULTS: In group K60, VAS, PHS and dose of morphine were lower than in other groups (p < 0.05). Satisfaction score was higher in group K60 and the nurse's satisfaction score was higher than the patient's in group K0 and K30 (p < 0.05). There was no significant difference in hospital days between groups. Side effects were negligible. CONCLUSIONS: Preoperative intravenous administration of ketorolac 60 mg in open cholecystectomy or choledochocystostomy could have a preemptive analgesic effect and give more satisfaction to patients. In the immediate postoperative period, pain status may be highest, so more attention and evaluation will be needed by pain management staffs for the proper management of acute pain.
Acute Pain ; Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Cholecystectomy ; Humans ; Hydrogen-Ion Concentration ; Ketorolac* ; Morphine ; Pain Management ; Pain, Postoperative* ; Postoperative Period

BACKGROUND: Epidural administration of local anesthetics and opiate or intravenous administration of opiate and ketorolac has proven to be effective in the treatment of postoperative pain. Studies that compare epidual morphine-bupivacaine vs intravenous nalbuphine-ketorolac administration showed conflicting results. We compared the ability and side effects of epidural (EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine-ketorolac for postoperative pain relief after cesarean delivery. METHOD: Sixty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg mixed with 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.0125% morphine and 0.125% bupivacaine (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 15 min) or intravenous bolus of nalbuphine 5 mg, followed by a IV-PCA with 0.05% nalbuphine and 0.15% ketorolac (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 30 min) for pain relief after cesarean delivery. The intensity of pain was assessed by the patient, who was unawared of the dose given, using a visual analog scale (VAS). To compare intensity of pain, VAS was used at 1, 6, 12, 24 and 40 hour after the end of surgery. RESULT : EPI-PCA group had significant lower visual analog scale (VAS) at immediate postoperative period, whereas no significant difference was observed when pain was assessed at other time sequence. Pruritus was more frequent with EPI-PCA group, although the incidence of other side effects were the same. CONCLUSION: We conclude that EPI-PCA or IV-PCA using morphine-bupivacaine or nalbuphine- ketorolac is relatively effective and safe method for the postoperative pain control. Although EPI-PCA with morphine-bupivacaine shows lower VAS at immediate postoperative period, IV-PCA with nalbuphine-ketorolac is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery.
Administration, Intravenous ; Analgesia* ; Analgesia, Patient-Controlled* ; Anesthetics, Local ; Bupivacaine ; Female ; Humans ; Incidence ; Ketorolac ; Morphine ; Nalbuphine ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Visual Analog Scale