Ketorolac,a new non-opioid analgesic: A single-blind trial versus buprenorphine in pain after orthopaedic surgery

Summary

A randomized single-blind, double-observer trial was performed to evaluate the efficacy of a new non-steroidal anti-inflammatory analgesic drug, ketorolac, in the treatment of post-orthopaedic surgery pain. Sixty patients with moderate to severe pain were studied; 30 patients were treated with ketorolac at a dose of 30?mg intramuscularly up to 4-times a day, whilst the other 30 patients received 0.3?mg buprenorphine intramuscularly up to 4-times a day. A significant reduction in the severity of the pain was recorded in both groups. Throughout the study, comparable efficacy was found between the two therapies although buprenorphine showed greater efficacy during the first 8 hours. Interestingly, the withdrawals due to adverse events were significantly less in the ketorolac group (p<0.001). This study, therefore, suggests that ketorolac may be a useful and more acceptable alternative to buprenorphine in the treatment of post-orthopaedic surgery pain.     

Safety and efficacy of ketorolac in children after cardiac surgery

Objective  To evaluate the nephrotoxic and opioid-sparing effects of ketorolac in children after cardiac surgery. Design  A retrospective cohort study. Setting  A Cardiac Critical Care Unit in a university-affiliated children’s hospital. Subjects  Children less than 18 years of age who underwent low-risk cardiac surgery from July 2002 to December 2005. Results  Among 248 children studied, 108 received ketorolac and 140 did not. The ketorolac group was older, included a larger proportion of atrial septum defect repairs and a smaller proportion of ventricular septum defect repairs compared to the control group. The median change in serum creatinine did not differ between the ketorolac group and the control group (% change [IQR]); 12% [1–25] increase versus 12% [−3 to 31] increase, P = 0.86. On postoperative day 0 or 1, the ketorolac group received less opioids than control group. There was no difference in duration of mechanical ventilation or in length of stay between groups. Conclusion  Ketorolac started in the first 12 h after a low-risk cardiac surgery in children is not associated with a measurable difference in renal function. The data suggest that ketorolac may be effective in reducing the exposure to opioids. Further studies are required to define subsets of children after cardiac surgery who could safely benefit from ketorolac therapy to reduce pain.     

Comparison of prednisolone 1%, rimexolone 1% and ketorolac tromethamine 0.5% after cataract extraction

Purpose To compare the efficacy, safety and patient comfort of two topical steroids (prednisolone 1% and rimexolone 1%) and a topical non-steroidal anti-inflammatory agent (ketorolac tromethamine 0.5%) after extracapsular cataract extraction.Methods Forty-five patients were enrolled in this prospective, randomized, double-blind study. They were assigned to receive topical treatment with either prednisolone, rimexolone or ketorolac tromethamine ophthalmic solution after phacoemulsification for cataract extraction. On postoperative days 1, 3, 5, 14 and 28 best-corrected visual acuity, intraocular pressure (IOP), slit-lamp examination of the anterior segment and report of the patients comfort were assessed and compared by Friedman rank time analysis.Results Regarding the primary outcome efficacy of inflammation control the assessment of cells did not differ (p=0.165), while flare in the anterior chamber was lowest (p=0.008) in the non-steroidal anti-inflammatory drug (NSAID) group. Surface inflammation was lowest with prednisolone (p=0.002). Regarding safety, visual acuity did not differ among the groups. In the prednisolone group one patient, however, responded to steroid treatment with elevated IOP and had to be excluded. In the remaining patients IOP was even lower in the two steroidal treatment groups than with ketorolac (p=0.030). One patient receiving ketorolac had to be excluded because a corneal erosion developed. Patient comfort was highest with prednisolone (p=0.041).Conclusions Ketorolac tromethamine provides good control of intraocular inflammation after cataract extraction without the risk of a steroidal IOP increase, which was also not observed under rimexolone therapy. The best surface inflammation control and patient comfort was observed with prednisolone, which remains a good choice.The authors have no proprietary interest in any of the equipment or materials used in this study.     

Randomized evaluation of ketorolac vs. fentanyl in elderly patients undergoing ambulatory surgery

Analgesic efficacy of a preemptive single dose preemptively of Ketorolac or Fentanyl in 102 elderly men undergoing general anaesthesia for multiple prostatic biopsies was assessed. Patients were randomly allocated to receive either (group A) Ketorolac 0.55 mg/kg intravenously (IV) 15 min before surgery or (group B) fentanyl 1, μg/kg IV 5 min before surgery. Anaesthesia was induced by means of propofol 15 mg/kg per h and maintained by means of propofol 7 mg/kg per h while patients were ventilated spontaneously using N₂O 70% in O2 via a to and fro system. Routine monitoring included mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO₂), respiratory rate (RR), end tidal CO₂ (EtCO₂). HR and MAP decreased during surgery with significantly lower values in the Fentanyl group. Fentanyl treated patients had higher ventilatory depression with frequent intraoperative apnoea. Group A needed supplemental doses of propofol to maintain adequate sedation. Sixty and 120 min postanaesthesia no differences were found for MAP, HR, RR, EtCO₂, pain and the tolerability of the procedure. The Ketorolac group had less adverse effects and could be discharged earlier.     

Ketorolac in Acute Headache Management

Twelve patients presenting to an emergency department in headache crisis were treated with Ketorolac tromethamine 60 mg. intramuscularly. All improved sufficiently to require no further emergent treatment. There was statistically significant improvement on all segments of the short form McGill Pain Questionnaire. This open label trial suggests that Ketorolac Tromethamine may be a useful agent in the treatment of headache crisis, and a controlled study to examine this is warranted.     

The effects of ketorolac tromethamine and baicalein on the levels of inflammatory factors in human synoviocytes

This study examined the effects of ketorolac tromethamine (KT) and baicalein (BE) on the levels of inflammatory factors in human synoviocytes. The fibroblast-like synoviocytes (FLS) cells were used to determine the possible regulatory effects of KT and BE (KTBE) on the levels of inflammatory factors in FLS cells. In addition, the levels of TNF-α, IL-6, and IL-1β mRNA expression in FLS cells induced by a TNF-α and IL-1β co-treatment were largely inhibited by a KTBE treatment. The level of FLS cells proliferation was increased by IL-1β and TNF-α, and strongly inhibited by KTBE treatment. The production of oxygen species (ROS) was inhibited by KTBE in FLS cells. KTBE appears to regulate the levels of mRNA that are important for regulating RA progression.     

川芎联合酮咯酸氨丁三醇对慢性颈肩腰腿痛患者氧化应激的影响

目的:探讨川芎联合酮咯酸氨丁三醇对慢性颈肩腰腿痛患者氧化应激的影响。方法:选取2017年2月至2018年2月青海大学附属医院收治的慢性颈肩腰腿痛患者152例,按照数字表法随机分为2组。对照组76例给予酮咯酸氨丁三醇治疗,观察组76例在对照组基础加用川芎治疗。比较2组患者临床疗效、疼痛视觉模拟评分法(VAS)评分、现有疼痛强度(PPI)评分的差异,并分析患者超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)水平及Barthel评分的变化;结果:观察组患者治愈率、总有效率分别为30.3%和90.8%,高于对照组的13.2%和77.6%,差异有统计学意义(P0.05);治疗2周后、治疗4周后观察组患者VAS评分、PPI评分均显著降低,也低于同期对照组(P0.05);治疗2周后、治疗4周后观察组患者MDA水平显著降低,也低于同期对照组,差异有统计学意义(P0.05);治疗2周后、治疗4周后观察组患者SOD、GSH-PX水平显著升高,也高于同期对照组(P0.05);治疗2周后、治疗4周后观察组患者Barthel评分显著升高,也高于同期对照组,差异有统计学意义(P0.05);结论:川芎联合酮咯酸氨丁三醇对慢性颈肩腰腿痛临床效果好,具有较高的临床有效率,能显著改善患者疼痛状态及氧化应激状态,日常生活能力也较高。     

酮咯酸氨丁三醇鼻喷雾剂的制备与主药含量测定

目的：制备酮咯酸氨丁三醇鼻喷雾剂,建立其主药含量测定方法。方法采用溶解法制备酮咯酸氨丁三醇鼻喷雾剂,以高效液相色谱法测定酮咯酸氨丁三醇的含量,主要色谱条件：色谱柱：C18柱（150mm ×4.6mm,5μm）;流动相：甲醇-水-冰醋酸（55∶44∶1）;流速：1.0mL· min -1;检测波长：323nm;柱温：30℃;进样量：10μL。进行其初步稳定性考察。结果制备的酮咯酸氨丁三醇鼻喷雾剂为几乎无色的澄清液体,酮咯酸氨丁三醇检测浓度在20~100μg· mL-1范围内,线性关系良好,平均回收率为100.41%（RSD=0.24%,n=9）;初步稳定性试验表明,该制剂对光不稳定。结论该制剂制备工艺简单、可行,主药含量测定方法准确,宜避光保存。     

2018年上半年北京市石景山医院酮咯酸氨丁三醇注射液的使用合理性分析

目的 了解北京市石景山医院住院患者使用酮咯酸氨丁三醇注射液的情况,并分析评价其用药合理性。方法 选取北京市石景山医院2018年1～6月使用酮咯酸氨丁三醇注射液的患者827例,从用药疗程、用法用量、联合用药等方面进行分析。结果 酮咯酸氨丁三醇注射液应用最多的科室是骨科;用药量月平均增长率为111.45%;共有371份（44.86%）存在用药不合理情况,其中疗程不合理的197例（23.82%）,用法用量不合理的216例（26.12%）,联用其他非甾体抗炎药（NSAIDs）的113例（13.66%）。不合理用药最多的用药疗程为6～10 d,构成比为85.79%。结论 北京市石景山医院酮咯酸氨丁三醇注射液的使用存在不合理用药情况,临床医师应严格遵循说明书、指南及循证医学用药,以确保酮咯酸氨丁三醇注射液的合理使用。     

酮咯酸氨丁三醇与地佐辛用于妇科腹腔镜手术后镇痛效果比较

目的 探讨酮咯酸氨丁三醇与地佐辛在妇科腹腔镜手术中镇痛效果.方法 120例妇科腹腔镜手术患者按照随机数字表法分为A组(60例)和B组(60例),A组术前给予酮咯酸氨丁三醇,B组术前给予地佐辛,观察两组镇痛效果.结果 A组拔管时间和意识恢复时间均明显的低于B组(P<0.05);A组不良反应发生率为6.7%,明显低于B组,差异有统计学意义(P<0.05).结论 妇科腹腔镜手术预先给予酮咯酸氨丁三醇与地佐辛均具有较好的镇痛效果,但地佐辛不良反应较多,术后苏醒时间延长.