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Analgesic Effects of Locally Administered Ketorolac-Based Analgesics after Breast Surgery: A Meta-Analysis of Randomized Controlled Trials.

Chen, Jen-Yin MD, PhD; Feng, I-Jung PhD; Loh, El-Wui PhD; Wang, Li-Kai MD, MS; Lin, Chao-Chun RN; Tam, Ka-Wai MD, PhD
Clinical Journal of Pain: Post Acceptance: September 14, 2017
doi: 10.1097/AJP.0000000000000556
Original Article: PDF Only

Objective: Reducing postoperative pain following breast surgery is crucial for rapid recovery and shortening hospital stay. Ketorolac, a nonsteroidal antiinflammatory drug, has been used as a postoperative analgesic in many surgical procedures. Here, 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 four RCTs with 255 patients. For meta-analysis, VAS at 1 and 6 hours of three 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 decrease postoperative pain in breast surgery patients, and the effect of local ketorolac is better than local bupivacaine. Therefore, ketorolac-based analgesics demonstrate considerable local infiltration during pain management after breast surgery.

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