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Narrative review shows that the short-term use of ketorolac is safe and effective in the management of moderate-to-severe pain in children.
Marzuillo, P, Calligaris, L, Amoroso, S, Barbi, E
Acta paediatrica (Oslo, Norway : 1992). 2018;(4):560-567
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Abstract
UNLABELLED In June 2013, the European Medicine Agency recommended limiting codeine use in paediatric patients, creating a void in managing moderate pain. We reviewed the literature published in English (1985-June 2017) on the pharmacokinetic, pharmacodynamic and safety profile of ketorolac, a possible substitute for codeine and opioids, for treating moderate-to-severe pain. We found that gastrointestinal side effects were mainly reported with prolonged use, significant bleeding was reported in adenotonsillectomy, and adverse renal effects appeared to be limited to patients with specific coexisting risk factors. CONCLUSION The short-term use of ketorolac appears to be safe for children in many situations.
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Analgesic Effects of Locally Administered Ketorolac-based Analgesics After Breast Surgery: A Meta-Analysis of Randomized Controlled Trials.
Chen, JY, Feng, IJ, Loh, EW, Wang, LK, Lin, CC, Tam, KW
The Clinical journal of pain. 2018;(6):577-584
Abstract
OBJECTIVE Reducing postoperative pain following breast surgery is crucial for rapid recovery and shortening hospital stay. Ketorolac, a nonsteroidal anti-inflammatory drug, has been used as a postoperative analgesic in many surgical procedures. We conducted a systemic review and meta-analysis on the efficacy of locally administered ketorolac-based analgesics in managing pain after breast surgery. METHODS We searched the PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry for randomized control trials (RCTs) published up to September 2016. The primary outcome was pain level assessed using a visual analog scale (VAS) at 1 and 6 hours following breast surgery. RESULTS We reviewed 4 RCTs with 255 patients. For meta-analysis, VAS at 1 and 6 hours of 3 similar RCTs were compared. At 1 hour, VAS scores were significantly lower in patients administered a ketorolac solution [weighted mean difference (WMD)=-2.04; 95% confidence interval (CI): -3.08 to -1.00] or ketorolac-bupivacaine solution (WMD=-2.30; 95% CI, -4.07 to -0.54) than in controls. At 6 hours, the ketorolac-bupivacaine solution reduced VAS scores significantly (WMD=-1.40; 95% CI, -2.48 to -0.32) compared with controls. However, at 1 hour, the ketorolac solution was significantly more effective than the bupivacaine solution was (WMD=-1.70; 95% CI, -2.81 to -0.59). DISCUSSION The effects of ketorolac-based analgesics vary as per the surgery and disease type. Locally administered ketorolac-based analgesics decreased postoperative pain in breast surgery patients, and the effect of local ketorolac was better than local bupivacaine. Therefore, ketorolac-based analgesics demonstrate considerable local infiltration during pain management after breast surgery.
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Pediatric Tonsillectomy and Ketorolac.
Phillips-Reed, LD, Austin, PN, Rodriguez, RE
Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses. 2016;(6):485-494
Abstract
BACKGROUND The use of ketorolac in children undergoing tonsillectomy remains limited because of the concern about postoperative bleeding. METHODS A search was performed addressing the question: For patients undergoing a surgical tonsillectomy, does a weight-appropriate single dose of intravenous ketorolac affect the incidence of postoperative hemorrhage? RESULTS Five systematic reviews met the inclusion criteria. A Cochrane Review included 15 studies with 1,101 pediatric subjects and focused on perioperative bleeding requiring intervention. Many of the systematic reviews appraised the same studies. Subgroup analysis often allowed assessment of the effects of ketorolac administration. FINDING There was no consensus on the increased risk of bleeding when nonsteriodal anti-inflammatory drugs such as ketorolac are given to pediatric patients undergoing tonsillectomy. The conclusions varied from ketorolac should not be used to it is safe to use with these patients. CONCLUSIONS The perianesthesia team must carefully weigh the risks and benefits before deciding to use ketorolac with this subset of patients.
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Intranasal ketorolac as part of a multimodal approach to postoperative pain.
Pergolizzi, JV, Taylor, R, Raffa, RB
Pain practice : the official journal of World Institute of Pain. 2015;(4):378-88
Abstract
Despite recent advances in the knowledge of pain mechanisms and pain management, postoperative pain continues to be a problem. Inadequately managed postsurgical pain has both clinical and economic consequences such as longer recovery times, delayed ambulation, higher incidence of complications, increased length of hospital stay, and potential to develop into chronic pain. Generally, opioids are the mainstay option for pain management in patients with moderate-to-severe postsurgical pain; however, opioids have significant side effects and have abuse potential. To improve patient and economic outcomes after surgery, postoperative pain guidelines have suggested incorporating a multi-modal/multi-mechanistic approach to pain treatment. A multi-modal approach is the simultaneous use of a combination of two or more (usually opioid and non-opioid) analgesics that provide two different mechanisms of actions. Utilizing a multi-modal approach may result in a greater reduction in pain vs. single therapies in addition to minimizing opioid use, thus reducing opioid related side effects. However, not all approaches may be effective for all types of patients and not all analgesics may be a viable option for outpatient settings, ambulatory surgery, or the fast-track surgical procedures. In this report, we present a review of the literature with a focus on intranasal ketorolac in order to provide a timely update regarding past, present, and future multi-modal treatment options for postoperative pain.
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Perspectives in anaesthesia for cancer surgery.
Forget, P, De Kock, M
Journal of cancer research and clinical oncology. 2014;(3):353-9
Abstract
BACKGROUND It is a fact that inflammatory scores are important prognostic factors in cancer surgery. Many data have been published last year showing that inflammation is a causative event in many cancers and a concomitant event in all malignant tumours. MONITORING OF THE INFLAMMATION What is new is that we can assess inflammatory status during the preoperative period of our cancer patients with simple and widely available parameters, such as the neutrophil/lymphocyte ratio. This kind of biomarkers will be helpful, for the clinicians, to stratify the patients and, for the researcher, to incorporate it in clinical trials. RATIONALE FOR TRIALS AFTER DATABASE ANALYSES Promising clinical trials, focusing on perioperative inflammation, are ongoing. Rationale for these trials came from database analyses. This kind of analyses must be extended to follow the long-term effects of our interventions. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS We have shown a correlation between non-steroidal anti-inflammatory drugs, especially ketorolac, and improved outcome (metastasis-free survival and/or overall survival) in breast and lung cancer patients. CONCLUSION Focusing on a high-risk group with preoperative inflammation could lead to a clinical trial to test the effect of ketorolac on cancer outcome.
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Ketorolac in the treatment of acute migraine: a systematic review.
Taggart, E, Doran, S, Kokotillo, A, Campbell, S, Villa-Roel, C, Rowe, BH
Headache. 2013;(2):277-87
Abstract
This systematic review examined the effectiveness of parenteral ketorolac (KET) in acute migraine. Acute migraine headaches are common emergency department presentations, and despite evidence for various treatments, there is conflicting evidence regarding the use of KET. Searches of MEDLINE, EMBASE, Cochrane, CINAHL, and gray literature sources were conducted. Included studies were randomized controlled trials in which KET alone or in combination with abortive therapy was compared with placebo or other standard therapy in adult patients with acute migraine. Two reviewers assessed relevance, inclusion, and study quality independently, and agreement was measured using kappa (k). Weighted mean differences (WMD) and relative risks are reported with 95% confidence intervals (CIs). Overall, the computerized search identified 418 citations and 1414 gray literature citations. From a list of 34 potentially relevant studies (k = 0.915), 8 trials were included, involving over 321 (141 KET) patients. The median quality scores were 3 (interquartile range: 2-4), and two used concealed allocation. There were no baseline differences in 10-point pain scores (WMD = 0.07; 95% CI: -0.39, 0.54). KET and meperidine resulted in similar pain scores at 60 minutes (WMD = 0.31; -0.68, 1.29); however, KET was more effective than intranasal sumatriptan (WMD = -4.07; 95% CI: -6.02 to -2.12). While there was no difference in pain relief at 60 minutes between KET and phenothiazine agents (WMD = 0.82; 95% CI: -1.33 to 2.98), heterogeneity was high (I(2) = 70%). Side effect profiles were similar between KET and comparison groups. Overall, KET is an effective alternative agent for the relief of acute migraine headache in the emergency department. KET results in similar pain relief, and is less potentially addictive than meperidine and more effective than sumatriptan; however, it may not be as effective as metoclopramide/phenothiazine agents.
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Ketorolac nasal spray--a new formulation of this non-narcotic pain reliever.
Wynn, RL
General dentistry. 2012;(2):90-2