Pharmacotherapy
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of repeat doses of intramuscular ketorolac tromethamine and morphine sulfate for analgesia after major surgery.
A multicenter, randomized, double-blind, parallel study in 542 patients with moderate or severe postoperative pain compared the analgesic efficacy and safety of intramuscular ketorolac 30 mg (324 patients), morphine 6 mg (110 patients), and morphine 12 mg (108 patients) administered as needed as often as every 2 hours for a maximum of 20 doses or 5 days. The efficacy of ketorolac 30 mg was comparable to that of morphine 12 mg on every efficacy measure (average pain intensity, average pain relief, mean overall medication rating, and percentage of patients withdrawing because of inadequate relief). Ketorolac was statistically superior to morphine 6 mg for average pain intensity and mean overall rating. Ketorolac-treated patients had fewer adverse events than those who received either morphine dose.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intravenous ketorolac tromethamine and morphine sulfate in the treatment of postoperative pain.
This study compared the efficacy and safety of ketorolac tromethamine and morphine sulfate in alleviating moderate or severe pain immediately after major surgery. One hundred twenty-two patients were randomly assigned to receive single intravenous injections of ketorolac 10 mg, ketorolac 30 mg, morphine 2 mg, or morphine 4 mg; patients could receive a second dose 15 minutes thereafter, upon request, and most received both available doses. Analgesic efficacy was measured by interviewing patients and assessing pain intensity and pain relief for 6 hours after the first medication administration. ⋯ One patient who took morphine 4 mg withdrew because of drowsiness; other common adverse events reported included nausea, vomiting, somnolence, and dyspepsia. There were no statistically significant differences in the frequency of adverse events among the treatment groups. Intravenous ketorolac is effective for the treatment of postoperative pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy and safety of single-dose oral and intramuscular ketorolac tromethamine for postoperative pain.
The efficacy and safety of the analgesic drug ketorolac tromethamine in the treatment of moderate to very severe postoperative pain was assessed in five dose-ranging studies with single-dose, double-blind, randomized, parallel-group designs. The drug was administered orally (2.5-200 mg, 352 patients in three trials) and intramuscularly (5-90 mg, 395 patients in two trials), and compared with placebo and reference drugs. Patients subjectively evaluated pain intensity and relief using verbal categoric and visual analog scales; efficacy values included pain intensity difference (PID), summed PID, and total pain relief. ⋯ Intramuscular ketorolac 10 and 30 mg were superior to intramuscular meperidine 50 and 100 mg. Ketorolac was well tolerated, with rates of adverse events generally lower than those of the opiate comparators. Ketorolac doses of 2.5 and 5 mg were less effective than higher doses; 10 mg or more resulted in faster onset of action and greater peak efficacy; 90 mg or more gave more prolonged analgesic effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intravenous ketorolac tromethamine versus morphine sulfate in the treatment of immediate postoperative pain.
Intravenous ketorolac tromethamine was compared with morphine sulfate for the relief of moderate to severe postoperative pain and for side effects in 125 women undergoing major abdominal gynecologic surgery. Patients were randomly assigned to receive an initial intravenous dose of ketorolac 10 mg, ketorolac 30 mg, morphine 2 mg, or morphine 4 mg, administered in a double-blind fashion. No other narcotics were administered in the 3 hours preceding the first dose of study drug. ⋯ With the dosage regimens used, neither drug adequately controlled moderate to severe pain in the immediate postoperative period. Patients receiving ketorolac experienced significantly less drowsiness than those given morphine, and some subjects in each experienced nausea. No serious adverse effects were reported.
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Randomized Controlled Trial Comparative Study Clinical Trial
Parenteral ketorolac: opiate-sparing effect and lack of cardiorespiratory depression in the perioperative patient.
Two studies evaluated the intraoperative and postoperative use of ketorolac, a nonopioid analgesic. Compared with the opioid analgesic alfentanil, ketorolac administered intraoperatively exerted no adverse effects on cardirespiratory functions (i.e., no changes in heart rate, arterial partial pressure of carbon dioxide, or mean arterial pressure, and no associated apnea). Analgesic efficacy of both agents was judged to be equal. ⋯ The lack of respiratory depression with ketorolac, which would be anticipated from its inability to bind to central opioid receptors, was also demonstrated. In the placebo group, arterial partial pressure of carbon dioxide was significantly increased postoperatively, whereas a similar increase was not found in the ketorolac group. Results of the two investigations demonstrate the absence of opioid effects with ketorolac, and support its use for intraoperative and postoperative analgesia in patients undergoing major surgery.