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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§,∥,¶,#

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 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.

*Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan

Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

§Center for Evidence-based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan

Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan

Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan

#Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan

Funding support: This work was supported by a research grant from Chi Mei Medical Center and Taipei Medical University (grant No.: 104CM-TMU-13). The sponsoring organization was not involved in the study design, data analysis, or interpretation.

Author Disclosure: All authors have no conflicts of interest or financial ties to disclose.

Reprints: Ka-Wai Tam, MD, PhD, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan (e-mail:

Received September 22, 2016

Accepted December 22, 2016

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