Ketorolac

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P109. OUTPATIENT OPEN GASTRIC BYPASS SURGERY. David Syn, MD, David E. Mangold, MD, Allison A. Cobb, NP, Covenant Medical Center, Lubbock, TX. Background: Laparoscopic gastric bypass surgery has become synonymous with minimally invasive bariatric surgery leading to shorter hospital length of stays, however, similar if not better results can be achieved with open gastric bypass surgery when attention is given to reduction of incision size and adequate analgesia. Methods: From June 2005 to November 2005, 75 consecutive primary open gastric bypass procedures were performed by a single surgeon. Average incision length was 10cm. Average operative time was 65 minutes. Rectus sheath block with 0.25% Marcaine was used in all patients. External pain pump with dual catheters tunneled into bilateral rectus sheaths delivering 2cc h of 0.25% Marcaine for 72hrs post-operatively was placed in all patients. Intravenous Ketorolac was given peri-operatively. Patients were discharged on oral hydrocodone. Average age was 43.1 years. 89% were females. Average BMI was 54.5 kg m2. Average number of life-threatening comorbidities per patient was 2.1.

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Biowet Pulawy Biowet Pulawy Biowet Pulawy WALA-Heilmittel GmbH WALA-Heilmittel GmbH Heel GmbH Pascoe Pharmaceutische Preparate GmbH DAGOMED-Pharma Sp. zo.o., Warszawa. Pioids are excellent analgesics but may cause significant problems when used in infants and children for ambulatory surgical procedures. In addition to the well-known risk of ventilatory depression, postoperative nausea and vomiting PONV ; is more likely with opioid usage. Besides, required compliance with regulatory procedures whenever opioids are used increases ambulatory care center costs. Nonopioid analgesics do not induce sedation or predispose to respiratory depression, PONV and urinary retention. Because of these reasons, acetaminophen and nonsteroidal anti-inflammatory drugs NSAIDS ; are preferred drugs during pediatric ambulatory surgical care. Both acetaminophen and ibuprofen are available for rectal use and may be administered soon after induction of anesthesia. They do not peak as rapidly as intravenously administered drugs, and therefore, ketorolac [Figure 1] is the agent of choice when rapidity and reliability of onset is desirable Ketorolac, a nonspecific NSAID, has a volume of distribution that is almost twice that of adults and an increased clearance but an elimination half-life t 1 2 beta ; that is similar in children and adults. The practical point to remember is that the dosing interval is the same as in adults. A dose of 0.5 mg kg results in therapeutic levels lasting six hours. Thus, when administered intravenously soon after induction, ketorolac may be continued orally six hours 0.3-0.5 mg kg ; postoperatively for the first day and then weaned over 48 hours. The daily maximum dosage should not exceed 90 mg. Ketorolac has not been implicated in postoperative bleeding following ambulatory surgi and loxapine.
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Fig. 9. Time course of systolic blood pressure sBP ; in SD rats fed a low-salt diet [0.02% NaCl wt wt ; ] during treatment with ketorolac 2 mg kg body wt 1 day 1 ; , meclofenamate 10 mg kg body wt 1 day 1 ; , or rofecoxib 10 mg kg body wt 1 day 1 ; . Insert: sBP on day 21. NS, normal salt; LS, low salt; K, ketorolac; M, meclofenamate; R, rofecoxib. Values are means SE of 8 animals each. * P 0.05, untreated vs. treated rats and lyrica and ketorolac. Physical dependence is a normal, expected neuropharmacological phenomenon, while addiction is a behavioral phenomenon.
BY PAUL H. ERNEST, MD That the NSAID nepafenac suspension 0.1% showed a greater concentration in the aqueous humor compared with ketorolac 0.4% and bromfenac 0.09% is a positive for anti-inflammatory surgical therapy and the treatment of cystoid macular edema CME ; . These findings prompt me to consider nepafenac suspension as my NSAID of choice. I use NSAIDs on every cataract and refractive lens exchange patient. I prescribe these drugs for 1 month t.i.d. after surgery, a strategy that I believe has kept the incidence of CME among my patients very low. I also use them preoperatively in certain eyes, such as those of patients with diabetes, who are more prone to CME. I also use nepafenac after a YAG laser capsulotomy on eyes implanted with an apodized refractive IOL to make sure the macula remains pristine. I have been using ketorolac; the reason I will consider switching is because nepafenac suspension penetrates the ocular tissues better. Also, I have not heard any complaints about nepafenac's comfort from patients, whereas I have had a few reports of stinging with other drugs I have used and pregabalin. NSAID, ketorolac minimizes the activation or sensitization of peripheral nociceptors. Unlike other opioids, tramadol causes minimal respiratory depression, shows more stable haemodynamics with no post operative nausea and vomiting and pruritis and low addiction liability and tolerance. In the past morphine9, pethidine10, 11 and fentanyl12, 13 have been shown to potentiate 'IVRA Block', but side effects seen with them make these drugs less popular. Review of literature did not show any published data on the use of tramadol in IVRA. Because of the advantages offered by tramadol and ketorolac, we decided to use these as components of IVRA. Earlier studies14, 15 have used 20-60mg of ketorolac for IVRA, whereas, parenteral dose of tramadol is 1mgkg-1 and hence for effective pain relief and minimal side effects, we decided to use ketorolac 30mg 1ml ; and tramadol 50mg 1ml ; in 40ml of 0.5% lignocaine. Control used was 1ml of saline in 40cc of 0.5% lignocaine. The solution was prepared with full asepsis. Addition of these agents did not show any appreciable change in the pH lignocaine-6.93, lignocaine + tramadol-6.9, and lignocaine + ketorolac-7.17 ; which could create a doubt as to the efficacy of the combination as compared to the control. Incidence of tourniquet pain intra-operatively in 26.66% of total patients can be because of inefficient exsanguination. As all these patients had painful limb and exsanguination was done by raising the limb above the heart level for 5 minutes without compression of the artery. This perhaps led to dilution of the IVRA drug, which resulted in inadequate analgesia and hence tourniquet pain intra-operatively. This could have been avoided by simultaneous arterial compression, while the extremity was being exsanguinated.16 All these patients were supplemented with general anesthesia till the end of surgery. Study of Reuben14 et al has shown decreased incidence of intra-operative tourniquet pain in ketorolac 60mg ; group. In our study with 30mg ketorolac no such reduction in the incidence of tourniquet pain was seen. Recent study by the same group15 has recommended ketorolac 20mg as the optimum dose to avoid side effects. The one other factor involved in the occurrence of side effects with IVRA appears to be the time involved between injection of solution and release of tourniquet, that is the injection release interval. No matter how short the surgical period, the tourniquet should not be released for at least 30 minutes. None of our patients had any adverse effects attributable to the technique and the drugs used. There was a significant difference between all three groups as to the time to first analgesic. Tramadol 50mg was significantly better as compared to ketorolac 30mg.

Ketorolac Oil Drops Ketorolac-free acid was made as per method published elsewhere.14 Ketorolac 0.2% wt vol ; solution was made in each of soybean and sesame oil, and 0.5% vol vol ; benzyl alcohol was added to each formulation.

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