Opioid-sparing Effect and Post Op Recovery
Opioid-sparing effects of ketorolac and its correlation with the recovery of postoperative bowel function in colorectal surgery patients: a prospective randomized double-blinded study.
Chen JY, Ko TL, Wen YR, Wu SC, Chou YH, Yien HW, Kuo CD.
Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Clin J Pain. 2009 Jul-Aug;25(6):485-9.
OBJECTIVES: Postoperative ileus (PI) is one of many common complications in major abdominal surgery. Postoperative Ileus results in patient discomfort, increased gastrointestinal leakage, prolonged hospital stay, and increased medical expenses. In this study, we have investigated the morphine-sparing effects of ketorolac and its correlation with the duration of Postoperative Ileus in patients with colorectal surgeries.
METHODS: We collected data from 102 patients who had received elective colorectal resection. The patients were randomly allocated into 2 groups and received intravenous patient-controlled analgesia (IVPCA) morphine (M group) or intravenous patient-controlled analgesia morphine plus ketorolac (M+K group). Time-scale morphine consumption (per 12 h), recovery of bowel functions (the first bowel movement and passage of flatus), pain scores, and opioid-related side effects were then recorded.
Patients in the morphine plus ketorolac group received 18.3% less morphine than those in the morphine group within 72 postoperative hours.
The maximal opioid-sparing effects of ketorolac appeared in 12 to 24 postoperative hours.
The onset of the first bowel movement and passage of flatus was significantly less in the morphine plus ketorolac group than in the morphine group.
The morphine group showed a 5.25 times greater risk of inducing PI, a result comparable with the morphine plus ketorolac group in colorectal surgery patients.
The addition of ketorolac to intravenous patient-controlled analgesia morphine has demonstrated
a clear opioid-sparing effect and benefits in regards to the shortening of the duration of bowel immobility.
We suggest that adding ketorolac to morphine intravenous patient-controlled analgesia be included in the multimodal postoperative rehabilitation program for the early restoration of normal bowel function.