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Journal of Anesthesiology Presentations. 2011, V 1, P 1 (Presented at ASA 2008)
The Analgesic Efficacy of Ketorolac and Ropivacaine Infusion for Postoperative Pain Management
Dawn McNiel, M.D., Rania Muhammad, M.D., Ram Manchandani, M.D., Murali Pagala, Ph.D., Darlene Saberito, R.N.
Neekianund Khulpateea M.D., Kalpana Tyagaraj, M.D.
Departments of Anesthesiology and OB/GYN, Maimonides Medical Center, Brooklyn, New York, United States, 11219.
INTRODUCTION
either 0.125% Ketorolac (Group 1) or 0.125%
Intravenous infusion of narcotics is a common
Ketorolac plus 0.5% Ropivacaine (Group 2).
method of treating postoperative pain, however
Patient scores to pain at rest, on coughing,
side effects such as nausea, vomiting, sedation,
and with movement, drowsiness, and nausea, and
K e t o r a l a c ( n = 3 0 )
and constipation are frequent concerns (1).
overall satisfaction were collected using a Visual
K e t o r a l a c + R o p v i c a i n e ( n = 3 0 )
Continuous infusion of local anesthetics such
Analog Scale (VAS) having 0 to 10 Numbers.
as Bupivacaine (2) via ON-Q® pump has been
Vomiting episodes were also noted.
useful in managing postoperative pain while
 The data were collected at the start and at 1
having fewer undesirable side effects. But these
hour, 6 hours, 12 hours, 24 hours and 48 hours
have short duration of action.
after ON-Q® pump infusion.
 Continuous infusion of non-steroidal anti-
Narcotics given for rescue analgesia, and use
inflammatory drugs (NSAIDs) such as Diclofenac
of antiemetics were also recorded.
at the wound site have shown to provide adequate
pain relief (3). These act at both central and
 Based on unpaired t-tests, there were no
peripheral sites.
significant differences in age, height and weight of
the patients between the two groups.
The primary objective of the present study is
VAS pain scores at rest, on coughing, or on
to evaluate the relative efficacies of Ketorolac
moving showed a consistent decline with time in
(NSAID) alone and Ketorolac plus Ropivacaine
both groups (Fig. 1A to 1C). A Two-Way
Anesthetic)
for postoperative
ANOVA between the initial and final pain scores
management in patients after gynecologic surgery.
showed significant difference (P<0.05) within the
two groups, but not between the 2 groups.
This was a prospective, randomized, double-
 The amount of rescue analgesia used
blinded study approved by the IRB. Sixty female
significantly decreased between the initial and 12
patients undergoing open gynecological surgeries
hr periods (P<0.05), but subsequently increased
consented to take part in the study.
within each group. There was no significant
Patients were excluded if they had allergies to
difference in the use of rescue analgesics between
NSAIDs or local anesthetics, sepsis, coagulation
the two groups (Fig. 2).
T i m e ( h o u r s )
problems, or refused to sign the informed consent.
 No significant difference in nausea, vomiting,
They were randomized into two equal groups,
drowsiness, and overall satisfaction between the
Ketoralac (n=30)
well matched for baseline characteristics.
two groups.
Ketoralac + Ropvicaine (n=30)
patients
received
CONCLUSION:
anesthesia.
 Our results suggest that Ketorolac alone is as
At the end of surgery, the surgeon inserted
efficacious as Ketorolac plus Ropivacaine
the dual catheters of an ON-Q® pump (Model
adequate pain relief, and opioid sparing effect.
PM005 from I-Flow Corporation) at the wound
REFERENCES:
site. A bolus dose of 30 ml saline with 10 mg
1. S.J.Bullish et al. Clin. Pharm. 1985, 4:48-52. Ketorolac (Group 1) or 30 ml saline with 10 mg
2. P.F. White et al. Anesth. Analg. 2003, 97:1303-9 Ketorolac plus 0.5% Ropivacaine (Group 2) was
3. P.M.L. Homme et al. SOAP, 2004, Ab. A22. Time (hours)
instilled at the wound site. Then ON-Q pump
infusion was started at 4 ml/hr with saline having

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