Intra-operative ketorolac 15 mg versus 30 mg for analgesia following cesarean delivery: a retrospective study

BackgroundKetorolac is a nonsteroidal anti-inflammatory drug used as part of multimodal analgesia in women undergoing cesarean delivery. The lowest effective dose of ketorolac that best optimizes analgesia without increasing side effects is unclear. We performed this retrospective study to compare the analgesic efficacy of 15 mg or 30 mg ketorolac administered intra-operatively to our obstetric population.MethodsWe included patients who underwent cesarean delivery under neuraxial anesthesia and received 15 mg or 30 mg of ketorolac intra-operatively. Our multimodal analgesic regimen is standardized and includes 150 µg spinal or 3 mg epidural morphine, 975 mg rectal acetaminophen, and 15–30 mg intravenous ketorolac within 15 min of surgery completion. The primary outcome was opioid use in the first 6 h after surgery. Secondary outcomes were opioid use at 24 and 48 h, opioid dose, pain scores, breastfeeding, postoperative serum creatinine and need for rescue anti-emetics.ResultsOne-thousand-three-hundred and forty-nine patients were analyzed (15 mg ketorolac n=999; 30 mg n=350). There was no difference between the two groups in patient demographics or intra-operative characteristics. There was no significant difference between groups for opioid use at 6 h after surgery (50.3% vs 52.0%, odds ratio [95% confidence interval] 1.13 [0.87 to 1.47]). There were also no significant differences between the groups for secondary outcomes.ConclusionsThere was no difference in opioid use between patients receiving either a 15 mg or a 30 mg dose of ketorolac given intra-operatively for postoperative analgesia following cesarean delivery.     

异丙酚复合酮咯酸氨丁三醇用于宫腔镜麻醉效果的临床观察

目的：探讨丙泊酚复合酮咯酸氨丁三醇（尼松）在宫腔镜麻醉中的应用效果。方法：选择200例宫腔镜检查作静脉全麻的患者,根据单纯用异丙酚和联合应用尼松、异丙酚随机分成A、B两组,观察患者术中生命体征、丙泊酚用量、术后清醒时间、呼吸抑制、不良反应,并进行比较。结果：B组对患者术中的SBP、心率影响及呼吸抑制明显低于A组;术后清醒时间和丙泊酚的用药总量均少于A组。结论：丙泊酚联合酮咯酸氨丁三醇用于宫腔镜检查麻醉可明显减少丙泊酚的用量,不良反应较少。     

酮咯酸氨丁三醇治疗外科疾病疼痛118例

目的;探讨酮咯酸氨丁三醇对外科疾病疼痛的镇痛效果.方法;外科疾病疼痛患者118例,给予酮咯酸氨丁三醇注射液30 mg,im,口服剂10～20 mg,po,每天最大剂量不超过120 mg,对剧烈疼痛给药30 min后无效者,可再肌内注射30 mg.结果;起效时间5～60 min,平均35 min,止痛时间为0.5～24 h,平均8.2 h.总有效率97.5%.结论;酮咯酸氨丁三醇镇痛抗炎作用显著,并且起效迅速,可用于临床各种外科性疼痛.     

酮咯酸氨丁三醇联合山莨菪碱治疗肾绞痛的疗效观察

目的：探讨酮咯酸氨丁三醇联合山莨菪碱治疗肾绞痛的疗效。方法选取2011—2013年沧州市中心医院急诊科收治的肾绞痛患者457例,随机分为治疗组（228例）与对照组（229例）。治疗组患者予以酮咯酸氨丁三醇联合山莨菪碱治疗,对照组患者予以盐酸哌替啶联合山莨菪碱治疗。观察两组患者临床疗效及不良反应（如恶心、呕吐、头晕、尿潴留、低血压、过敏等）发生情况。结果两组患者总有效率比较,差异无统计学意义（ P ＞0.05）;治疗组患者不良反应发生率低于对照组,差异有统计学意义（P ＜0.05）。结论酮咯酸氨丁三醇联合山莨菪碱治疗肾绞痛的疗效显著,且不良反应少,安全性高。     

酮咯酸氨丁三醇在子宫输卵管超声造影中的超前镇痛作用

目的探讨酮咯酸氨丁三醇在经阴道四维子宫输卵管超声造影（TVS 4D-HyCoSy）中的超前镇痛作用。 方法选取2018年5月至2019年3月于云南省第三人民医院因不孕症拟行TVS 4D-HyCoSy的患者102例。依据检查前使用镇痛药物的不同,将其分为观察组（造影前半小时肌内注射酮咯酸氨丁三醇）51例和对照组（造影前半小时肌内注射阿托品）51例,比较2组的镇痛效果及不良反应发生率。 结果观察组镇痛总有效率为96.1%（49/51）,对照组总有效率为82.4%（42/51）。观察组显效3例,有效46例,无效2例;对照组有效42例,无效9例,无一例显效。观察组超前镇痛效果优于对照组（Z=-2.707,P=0.007）。观察组不良反应发生率较对照组低（3.9% vs 23.5%）,差异有统计学意义（χ²=8.279,P=0.004）。 结论TVS 4D-HyCoSy前使用酮咯酸氨丁三醇超前镇痛的效果优于阿托品,值得临床推广运用。     

Acid and base degraded products of ketorolac

The stability of ketorolac tromethamine was investigated in acid (0.5 M HCl) and alkaline conditions (0.5 M NaOH), using the same procedure reported by Devarajan et al. [2]. The acid and base degradation products were identified by liquid chromatography–mass spectrometry (LC–MS).     

肌肉和静脉注射痛力克术后镇痛效果的观察

痛力克是作用于外周的非麻醉性、非甾体类抗炎剂，通过抑制外周或中枢的前列腺素合成起镇痛作用。作者对６０例（两组各３０例）ＡＳＡⅠ～Ⅱ级择期手术患者在术后回病房切口微痛时，肌肉和静脉单次注射等效剂量痛力克３０ｍｇ，观察镇痛总有效率均为１００％，显效率分别为６６．７％和７０％，起效时间为１８±４．５和１５±３．４ｍｉｎ，完全镇痛时间为９０５±６２０．０３和５６３±４３９．５９ｍｉｎ。认为肌肉注射不受客观条件限制，使用方便可靠，为首选方法     

Central effect of Ketorolac involving NMDA receptors activity

Possible central mechanisms underlying the analgesic action of Ketorolac, a non-steroidal antiinflammatory drug (NSAID) have been investigated using an iontophoretic approach. We found that the excitation induced by N-methyl- -aspartate (NMDA) on spinal wide dynamic range (WDR) neurons was prevented, or reduced, by Ketorolac applied before or after the start of the NMDA ejection. The data suggest that Ketorolac can achieve its central analgesic effect by interfering with the NMDA receptor activity on the spinal neurons.