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Use of Ketorolac After Outpatient Urogynecologic Surgery: A Randomized Control Trial

Trowbridge, Elisa R., MD*; Kim, Dahea, MD*; Caldwell, Lauren, MD*; Franko, Denise, MD; Jackson, Jessica Nicole, MD*; Shilling, Ashley, MD; Hullfish, Kathie L., MD*

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 281–286
doi: 10.1097/SPV.0000000000000459
Original Articles

Objective Patient surveys highlight a prevalence of moderate to severe pain in the postanesthesia care unit. Multimodal analgesia has been promoted to improve this with fewer opioid-induced adverse effects. The aim of this study was to evaluate the opioid sparing and analgesic effect of postoperative intravenous (IV) ketorolac after outpatient transvaginal surgery.

Methods Forty patients were enrolled in this institutional review board–approved, randomized, double-blind, placebo-controlled study, to receive either 30 mg of IV ketorolac or IV saline placebo postoperatively. Pain was assessed by visual analog scale at timed intervals. Narcotic pain medication was provided upon request. Narcotic use was reassessed by telephone 5 to 7 days postoperatively. Categorical characteristics were compared by χ2. Continuous variables were evaluated by Mann-Whitney U test.

Results Twenty patients were randomized to each group. Groups were similar in age, health, and operative factors. There was no significant difference in mean pain scores at any interval. The ketorolac group had a total morphine equivalent consumption median of 7.5 mg versus 4.0 mg for placebo, which was not significant (P = 0.17). Total use of narcotic pills postoperatively was equivalent (median, 5). There was no difference in postoperative nausea. One Dindo grade II complication was reported in the ketorolac group of a postoperative pelvic hematoma requiring transfusion.

Discussion Intravenous ketorolac administered after outpatient transvaginal surgery did not result in a reduction of pain scores or total morphine consumption. There was one Dindo grade II complication in the ketorolac group. Larger randomized control trials are needed to validate these findings.

Intravenous ketorolac administered after outpatient transvaginal surgery did not result in a reduction of pain scores or total morphine consumption.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics/Gynecology and Urology, University of Virginia, Charlottesville;

Department of Obstetrics/Gynecology, Dartmouth-Hitchcock Medical Center Lebanon, NH; and

Department of Anesthesia University of Virginia, Charlottesville, VA.

Correspondence: Elisa R. Trowbridge, MD, University of Virginia Health System, PO Box 801305, Charlottesville, VA 22908. E-mail: etrowbridge@virginia.edu.

The author has declared that there are no conflicts of interest.

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