Bosek V, Cox C E
Department of Anesthesiology, University of South Florida, College of Medicine, Tampa 33612, USA.
Ann Surg Oncol. 1996 Jan;3(1):62-6. doi: 10.1007/BF02409053.
Ketorolac is a parenteral nonsteroidal antiinflammatory drug (NSAID). Two features have limited its clinical utility: tendency to elicit kidney failure and inability to produce complete analgesia. Because most NSAIDs are weak acids (pKa 3-5) and become concentrated in acidic tissues, such as injured and inflamed tissues, we hypothesized that local administration may enhance its analgesic efficacy while lowering the potential for systemic complications.
We conducted a randomized, placebo-controlled study of 60 group I-II (American Society of Anesthesiology criteria) mastectomy patients, 20 in each group. Near the end of surgery and every 6 h postoperatively, 20 ml of the study solution containing normal saline with or without 30 mg of ketorolac were administered simultaneously either via a Jackson-Pratt drain or intravenously in a double-blind fashion. The quality of pain control, the amount and character of the drain fluid, incidence of nausea and vomiting, length of stay in the postoperative care unit, and amount of morphine used for treatment of break-through pain were recorded.
Intraoperative administration of ketorolac resulted in better quality of pain control in the immediate postoperative period regardless of route of administration. The incidence of nausea was significantly higher in the placebo group, and drain output in the ketorolac groups did not exceed the output in the placebo group.
Analgesic of the locally administered ketorolac is equally effective to the efficacy of ketorolac administered intravenously.
酮咯酸是一种非肠道用非甾体抗炎药（NSAID）。有两个特性限制了其临床应用：引发肾衰竭的倾向和无法产生完全镇痛效果。由于大多数NSAID是弱酸（pKa 3 - 5），并在酸性组织（如受伤和发炎的组织）中浓缩，我们推测局部给药可能会增强其镇痛效果，同时降低全身并发症的可能性。
我们对60例I-II级（美国麻醉医师协会标准）乳房切除术患者进行了一项随机、安慰剂对照研究，每组20例。在手术接近尾声时以及术后每6小时，通过杰克逊-普拉特引流管或静脉内以双盲方式同时给予20毫升含生理盐水且有或无30毫克酮咯酸的研究溶液。记录疼痛控制质量、引流液的量和性质、恶心和呕吐的发生率、术后护理单元的住院时间以及用于治疗突破性疼痛的吗啡用量。
无论给药途径如何，术中给予酮咯酸在术后即刻能产生更好的疼痛控制质量。安慰剂组恶心的发生率显著更高，酮咯酸组的引流量未超过安慰剂组。
局部给予酮咯酸的镇痛效果与静脉给予酮咯酸的效果相同。
