Indomethacin and ketorolac given preoperatively are equally effective in reducing early postoperative pain after laparoscopic cholecystectomy.

OBJECTIVE

To evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) on pain after laparoscopic cholecystectomy.

DESIGN

A prospective, randomized, placebo-controlled, double-blind study.

SETTING

A university hospital.

PATIENTS

Fifty-two patients with cholelithiasis but without known allergy to one of the study drugs, history of bleeding, peptic ulcer disease, known cardiac, lung or renal disease, abnormal liver function or use of opiates or NSAIDs within 2 weeks before operation. Patients were assigned to one of three groups and treatment was randomized by placing the drugs in sealed, numbered envelopes.

INTERVENTION

Administration of the NSAIDs ketorolac, intramuscularly, or indomethacin, rectally, before laparoscopic cholecystectomy.

MAIN OUTCOME MEASURES

Postoperative pain scored on a a visual analogue scale and by nurse assessment, total dose of fentanyl citrate given, and nausea or emesis.

RESULTS

Patients in the placebo group reported significantly more pain than either NSAID group (p<0.05) and were reported as having significantly more pain by the nurses (P<0.05). These patients were subsequently treated with a higher mean postoperative dose of fentanyl citrate than either NSAID group (p<0.05). Furthermore, the placebo group reported more nausea and emesis (p<0.05). There was no significant difference in any of the parameters measured between the ketorolac or indomethacin group.

CONCLUSIONS

The data demonstrate that the NSAIDs ketorolac and indomethacin, administered preoperatively, decrease early postoperative pain and nausea after laparoscopic cholecystectomy and are equally efficacious in producing these results.