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.