Management of pain treatment in the early postoperative period. Practice of using ketorolac. A clinical case

Authors

  • Dmytro Dmytriiev National Pirogov Memorial Medical University, Vinnytsia
  • A Andriiets National Pirogov Memorial Medical University, Vinnytsia
  • E Andriiets National Pirogov Memorial Medical University, Vinnytsia
  • V Bankivsky National Pirogov Memorial Medical University, Vinnytsia
  • S Yatsenko National Pirogov Memorial Medical University, Vinnytsia

DOI:

https://doi.org/10.31636/pmjua.v5i3.3

Keywords:

Ketorolac, analgesia, clinical case, pain

Abstract

The current strategy of rational perioperative analgesia involves reducing the use of opioid analgesics and preventing associated side effects. Today it is known that the use of opioid analgesics can further lead to the development of hyperalgesia. Opioid-induced hyperalgesia is an adaptive response of the body in response to exogenous administration of opioids, the mechanisms of development of which are associated with the activation of the central glutamatergic system and the release of spinal dinorphins. In contrast, gabapentin, NSAIDs, and ketamine have opioid-preserving properties, reducing the number of opioid-associated side effects. Hyperalgesia is a condition that underlies the formation of chronic pain and develops regardless of the degree of postoperative wound repair.

For the treatment of pain in the postoperative period, the main group of treatment agents are opioid analgesics, which are prescribed to 60% of patients. However, with severe pain, there is a need for opioids in doses that exceed the standard recommended. It is known that the tactics of increasing the dose of opioid analgesics leads to an increase in the frequency of adverse reactions: severe sedation, respiratory depression, nausea, vomiting, intestinal paresis, dysfunction of the biliary and urinary systems, hallucinations. In order to reduce side effects, the doctor reduces the dose of opioids, which is accompanied by inadequate analgesia.

Given the above, clinicians prescribe additional drugs of other drug groups that can enhance the analgesic effect of opioids. An important aspect is the ability to reduce the dose of opioids.

Our data and data of other authors. Until recently, NSAIDs were rarely used in intensive care units, mainly in mild to moderate pain.

Downloads

Download data is not yet available.

References

Lebedeva RN, Nikoda VV. Pharmacotherapy of acute pain; M.: AIRART, 1998;184

Burns JW, Aitken HA, Bullingham RE, McArdle CS, Kenny GN. Double-blind comparison of the morphine sparing effect of continuous and intermittent im administration of ketorolac. BJA: British Journal of Anaesthesia. 1991 Sep 1;67(3):235–8.

Ferrante FM, Boncones TR. Postoperative pain. Moscow: Medicine; 1998;620.

Ilias W, Jansen M. Pain control after hysterectomy: an observer-blind, randomised trial of lornoxicam versus tramadol. The British journal of clinical practice. 1996 Jun;50(4):197.

Kehlet H, Mather LE. The value of NSAIDs in the management of postoperative pain. Drugs. 1992;44(suppl 5):1–63.

Rosenow DE, Van Krieken F, Stolke D, Kursten FW. Intravenous administration of lornoxicam, a new NSAID, and pethidine for postoperative pain. Clinical Drug Investigation. 1996 Jan 1;11(1):11–9.

Tamkaeva MA, Kotselapova EYu., Sugaipov AA, Shamuilova MM. The effectiveness of ketorolac for the relief of acute pain syndromes. Acute and urgent conditions in a doctor’s practice. 2013;6 (37):12–16.

Maksimov ML. Modern approaches to the therapy of pain syndrome. Russian Medical Journal. 2013;34:1734–1737.

ASP Committeeon Taxonomy [Electronic resource]. URL: http://www.iasp-pain.org

Osipova NA, Abuzarova GR, Petrova VV. Principles of using analgesics for acute and chronic pain. M: FGBU “MNIOI im. PA Gertsena”, 2010. 67.

Karateev AE, Yakhno NN, Lazebnik LB and others. Application of non-steroidal anti-inflammatory drugs. Clinical guidelines. M .: IMA-PRESS, 2009.167 p.

Shavlovskaya OA Clinical efficacy and tolerability of ketorolac in the treatment of pain syndromes. Consilium Medicum. 2013;2:85–88.

Lebedeva RN Non-steroidal anti-inflammatory and other non-narcotic analgesics in the treatment of acute pain [Electronic resource]. URL: http: // www. medlibrary.ru/ library/?rubric_id=15

Gillis JC, Brogden RN. Ketorolac. Drugs [Internet]. Springer Science and Business Media LLC; 1997 Jan;53(1):139–88. Available from: http://dx.doi.org/10.2165/00003495– 199753010–00012

Voznesensky AG. Clinical pharmacology of nonsteroidal anti-inflammatory drugs [Electronic resource]. URL: www. volgadmin.ru/vorma/archiv

Dyukova GM. Treatment of chronic pain syndromes and depression. Out-patient reference book. 2007;12:54–58.

Egorova OA. Efficacy and safety of Ketorol in pain syndrome in the clinic of ambulatory surgical dentistry. Dentistry. 2009;6:53–54.

Register of drugs of Russia [Electronic resource]. URL: https://www.rlsnet.ru/tn_index_id_24445.htm

Lynn AM, Bradford H, Kantor ED, Seng K-Y, Salinger DH, Chen J, et al. Postoperative Ketorolac Tromethamine Use in Infants Aged 6-18 Months: The Effect on Morphine Usage, Safety Assessment, and Stereo-Specific Pharmacokinetics. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2007 May;104(5):1040–51. Available from: http://dx.doi.org/10.1213/01.ane.00002 60320.60867.6c

Vadivelu N, Gowda AM, Urman RD, Jolly S, Kodumudi V, Maria M, et al. Ketorolac Tromethamine – Routes and Clinical Implications. Pain Practice [Internet]. Wiley; 2014 Apr 16;15(2):175–93. Available from: http://dx.doi. org/10.1111/papr.12198

Rainer TH, Jacobs P, Ng YC, Cheung NK, Tam M, Lam PK, Wong R, Cocks RA. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial. Bmj. 2000 Nov 18;321(7271):1247.

Henderson SO, Swadron S, Newton E. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic. The Journal of emergency medicine. 2002 Oct 1;23(3):237–41.

McGuire DA, Sanders K, Hendricks SD. Comparison of ketorolac and opioid analgesics in postoperative ACL reconstruction outpatient pain control. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1993 Dec 1;9(6):653– 61.

Менеджмент лікування болю в раньому післяопераційному періоді. Практика використання кеторолаку. Клінічний випадок

Published

2020-11-04

How to Cite

1.
Dmytriiev D, Andriiets A, Andriiets E, Bankivsky V, Yatsenko S. Management of pain treatment in the early postoperative period. Practice of using ketorolac. A clinical case. PMJUA [Internet]. 2020Nov.4 [cited 2020Nov.28];5(3):18-26. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/231

Issue

Section

Clinical thinking