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The assessment of changes in macular thickness in diabetic and non-diabetic patients: the effect of topical ketorolac on macular thickness change after ND:YAG laser capsulotomy.
Yılmaz, U, Küçük, E, Ulusoy, DM, Özköse, A, Ataş, M, Demircan, S, Yuvacı, I
Cutaneous and ocular toxicology. 2016;(1):58-61
Abstract
PURPOSE The purpose of our study is to assess the changes in macular thickness (MT) in diabetic and non-diabetic patients and to research effects of topical ketorolac (Acular®, Allergan, Irvine, CA) on MT change after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy. MATERIAL AND METHODS This study involved 88 eyes of 88 patients diagnosed as posterior capsule opacification (PCO). Patients were divided into four groups according to presence of diabetes mellitus (DM) and drugs used after capsulotomy. Group 1: Patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (22 patients). Group 2: Patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (20 patients). Group 3: Patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (22 patients). Group 4: Patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (24 patients). A plus-shaped capsulotomy was performed using VISULAS® YAGIII (Carl Zeiss) laser microscope. MT measurement with Cirrus SD-OCT (Carl Zeiss Opthalmic System Inc., Model 400, Dublin, CA, Software 5) were done. Measurements were done before laser, and on the first day, first week, first month, third month and sixth month after laser capsulotomy. We compared the four groups for MT change during 6 months. RESULTS Group 1 involving patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy had increased MT at the first week, and the first, third, and sixth month after laser (p < 0.001). Group 3 involving patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) had increased MT at the first week, and at the first and third month, there was no statistically significant difference at the sixth month (p > 0.05). There was no statistically significant increase in MT during the follow-up period in group 2 involving patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy and group 4 involving patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (p > 0.05). CONCLUSION An increase in MT can be observed after Nd:YAG laser capsulotomy, especially in diabetic patients. Adding topical ketorolac (Acular®, Allergan, Irvine, CA) to topical Fluorometholon (FML®, Allergan, Irvine, CA) therapy after YAG laser capsulotomy can prevent this increase.
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A Novel Pharmacologic Activity of Ketorolac for Therapeutic Benefit in Ovarian Cancer Patients.
Guo, Y, Kenney, SR, Cook, L, Adams, SF, Rutledge, T, Romero, E, Oprea, TI, Sklar, LA, Bedrick, E, Wiggins, CL, et al
Clinical cancer research : an official journal of the American Association for Cancer Research. 2015;(22):5064-72
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Abstract
PURPOSE We previously identified the R-enantiomer of ketorolac as an inhibitor of the Rho-family GTPases Rac1 and Cdc42. Rac1 and Cdc42 regulate cancer-relevant functions, including cytoskeleton remodeling necessary for tumor cell adhesion and migration. This study investigated whether administration of racemic (R,S) ketorolac after ovarian cancer surgery leads to peritoneal distribution of R-ketorolac, target GTPase inhibition in cells retrieved from the peritoneal cavity, and measureable impact on patient outcomes. EXPERIMENTAL DESIGN Eligible patients had suspected advanced-stage ovarian, fallopian tube or primary peritoneal cancer. Secondary eligibility was met when ovarian cancer was confirmed and optimally debulked, an intraperitoneal port was placed, and there were no contraindications for ketorolac administration. R- and S-ketorolac were measured in serum and peritoneal fluid, and GTPase activity was measured in peritoneal cells. A retrospective study correlated perioperative ketorolac and ovarian cancer-specific survival in ovarian cancer cases. RESULTS Elevated expression and activity of Rac1 and Cdc42 was detected in ovarian cancer patient tissues, confirming target relevance. Ketorolac in peritoneal fluids was enriched in the R-enantiomer and peritoneal cell GTPase activity was inhibited after ketorolac administration when R-ketorolac was at peak levels. After adjusting for age, AJCC stage, completion of chemotherapy, and neoadjuvant therapy, women given perioperative ketorolac had a lower hazard of death (HR, 0.30; 95% confidence interval, 0.11-0.88). CONCLUSIONS Ketorolac has a novel pharmacologic activity conferred by the R-enantiomer and R-ketorolac achieves sufficient levels in the peritoneal cavity to inhibit Rac1 and Cdc42, potentially contributing to the observed survival benefit in women who received ketorolac.
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The effect of intravenous ketorolac on capsaicin-induced deep tissue hyperalgesia.
Kumar, K, Polston, GR, Wallace, MS
Anesthesia and analgesia. 2006;(3):696-702
Abstract
Preclinical and clinical studies have emphasized that persistent small afferent input will induce a state of central facilitation that can be attenuated by systemically administered nonsteroidal antiinflammatory drugs. However, these studies have been performed using cutaneous models of hyperalgesia. In this study we evaluated the effects of IV ketorolac on an experimental model of deep tissue hyperalgesia using IM capsaicin. We used a double-blind, placebo-controlled, crossover design. Ten subjects received 60 mg of ketorolac or placebo in 2 sessions separated by 1 wk. Capsaicin (100 microg in 10 microL) was then injected into the flexor carpi ulnaris muscle of the left forearm. After injection, spontaneous pain scores, pressure pain scores, gripping pain, pain distribution, and pain quality were recorded at 0, 5, 10, 15, 20, and 25 min. Cutaneous allodynia and dysesthesia were then mapped and thermal and mechanical thresholds were measured. The IM injection of capsaicin resulted in a reliable report of pain, hyperalgesia, and referred pain. Ketorolac had no effect on spontaneous pain, elicited pain, pain distribution, or secondary hyperalgesia induced by capsaicin. The findings of this study support the feasibility of further pharmacological studies using the IM capsaicin pain model.
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Co-analgesic effect of ketorolac after thoracic surgery.
Boussofara, M, Mtaallah, MH, Bracco, D, Sellam, MR, Raucoles, M
La Tunisie medicale. 2006;(7):427-31
Abstract
Thoracotomies are painful surgical procedures and adequate pain relief is associated with improved respiratory function and fewer respiratory complications. After thoracotomy for lung resection, patients received morphine-based patient-controlled analgesia (PCA). Three groups were prospectively and randomised investigated: patients receiving preemptive ketorolac, those given postoperative ketorolac and controls. No differences among groups were found for demographic data, anaesthesia and surgery durations, or for the amounts of anaesthesia drugs administered. The blood losses were also comparable: 565 +/- 374 ml for the preemptive ketorolac group. 749 +/- 491 ml for the postoperative ketorolac group and 674 +/- 323 ml for the controls. At 48 h after surgery, compared to controls, morphine consumption was 36% lower for the preemptive ketorolac group and 17% lower for postoperative ketorolac group (p < 0.05). No statistically significant differences were observed for pulmonary function tests. These results suggest that non-steroidal anti-inflammatory drugs can reduce the opioid requirements after thoracic surgery but do not improve lung function.
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Intranasal ketorolac challenge for the diagnosis of aspirin-exacerbated respiratory disease.
White, A, Bigby, T, Stevenson, D
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2006;(2):190-5
Abstract
BACKGROUND Intranasal administration of aspirin-lysine has been used in Europe for the diagnosis of aspirin-exacerbated respiratory disease. It has a low adverse effect profile and is believed to be safer for asthmatic patients, particularly those with a low baseline forced expiratory volume in 1 second, in whom oral aspirin challenge would be contraindicated. Ketorolac, a nonsteroidal anti-inflammatory drug useful for severe pain, is available in the United States in parenteral form. OBJECTIVE To determine whether ketorolac nasal challenge has acceptable specificity and sensitivity for diagnosing aspirin-exacerbated respiratory disease. METHODS Twenty-nine patients with suspected aspirin-exacerbated respiratory disease were challenged with nasal ketorolac before oral challenge and desensitization with aspirin. Symptoms, objective changes in nasal examination findings, and peak nasal inspiratory flow values were recorded. Nasal lavage fluid for cysteinyl leukotriene analysis was collected. Ketorolac doses of 2.1, 5.2, or 7.8 mg were administered and compared with the results of oral aspirin challenge. RESULTS Eighteen patients had a positive challenge reaction to oral aspirin. Ketorolac nasal inhalation had a sensitivity of 78% and a specificity of 64%. Patients in the reactor group had significantly higher levels of cysteinyl leukotrienes after ketorolac challenge than in the nonreactor group. Mild bronchospasm occurred in 3 patients, and 2 of these occurred at higher starting doses of ketorolac. CONCLUSIONS Nasal ketorolac administration is a reasonably accurate and safe method for diagnosing aspirin-exacerbated respiratory disease.
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A randomised, double-blind trial of topical ketorolac vs artificial tears for the treatment of episcleritis.
Williams, CP, Browning, AC, Sleep, TJ, Webber, SK, McGill, JI
Eye (London, England). 2005;(7):739-42
Abstract
PURPOSE To determine whether topical ketorolac (Acular) is more effective than artificial tears in treating the signs and symptoms of idiopathic episcleritis. METHODS In this prospective, randomised, double-blind study, 38 eyes of 37 patients presenting with idiopathic episcleritis were allocated to receive either topical ketorolac (0.5%) or artificial tears three times a day for 3 weeks. The severity of patients' signs (episcleral injection and the number of clock hours affected) were recorded at weekly intervals. Patients' symptoms (perceived redness and pain scores) were recorded using a daily diary. RESULTS There was no significant difference in the ophthalmic signs between the two groups at each assessment, including intensity of episcleral injection and the number of clock hours affected. No significant difference was found in the time to halve the baseline redness intensity scores (4.4 vs 6.1 days, P=0.2) or pain scores (3.6 vs 4.3 days, P=0.55). Significantly more patients on ketorolac reported stinging at the first follow-up visit (P<0.001). CONCLUSION Topical ketorolac is not significantly better than artificial tears in treating the signs or symptoms of idiopathic episcleritis.
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Effect of administration of ketorolac and local anaesthetic infiltration for pain relief after laparoscopic-assisted vaginal hysterectomy.
Kim, JH, Lee, YS, Shin, HW, Chang, MS, Park, YC, Kim, WY
The Journal of international medical research. 2005;(4):372-8
Abstract
The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.
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Prospective, randomized trial of diclofenac and ketorolac after refractive surgery.
Narváez, J, Krall, P, Tooma, TS
Journal of refractive surgery (Thorofare, N.J. : 1995). 2004;(1):76-8
Abstract
PURPOSE To compare the effectiveness of diclofenac and ketorolac in relieving corneal pain after refractive surgery, and determine if there is a difference in stinging on instillation. METHODS Thirty patients were randomized prospectively to postoperative diclofenac in one eye and ketorolac in the other. Patients and surgeon did not know which medications were used. Ocular postoperative pain and discomfort on instillation of medication were measured after radial keratotomy with a visual analog scale and a questionnaire. RESULTS Both medications were highly effective in relieving pain. There was no significant difference in pain relief, or stinging on instillation (P = .29). CONCLUSION There was no statistical difference in the effectiveness of the medications on pain relief, or in stinging on instillation.
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[Ketorol in ENT practice].
Luchikhin, LA, Gospodar', MA, Knonova, NA, Aksenova, OV
Vestnik otorinolaringologii. 2004;(5):42-5
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Preoperative intravenous tramadol versus ketorolac for preventing postoperative pain after third molar surgery.
Ong, KS, Tan, JM
International journal of oral and maxillofacial surgery. 2004;(3):274-8
Abstract
The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative intravenous tramadol versus ketorolac in preventing pain after third molar surgery. Sixty-four patients undergoing elective third molar surgery were randomly assigned into one of the two groups (32 in each group): Group I received tramadol 50 mg, and Group 2 received ketorolac 30 mg intravenously preoperatively before the surgery. After injection of the study drugs, a standard intravenous sedation technique was administered and the impacted third molars were removed under local anaesthetic. The difference in postoperative pain was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, median time to rescue analgesic, postoperative acetaminophen consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac versus tramadol group (P = 0.05, Mann-Whitney U-test). Patients also reported significantly longer median time to rescue analgesic (9.0 h versus 7.0 h, P = 0.007, log rank test), lesser postoperative acetaminophen consumption (P = 0.02, Mann-Whitney U-test) and better global assessment (P = 0.01, chi2 test) for the ketorolac versus tramadol group. Preoperative intravenous ketorolac 30 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain.