Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery : A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial

Prospective randomized double-blind placebo-controlled study. The objective of this study was to assess the efficacy of Ketorolac in reducing postoperative pain and morphine requirements following primary multilevel lumbar decompression surgery. The use of opioid medications following surgical interventions can be complicated by related side effects such as respiratory depression, somnolence, urinary retention, and delayed time to oral intake. The use of Ketorolac, a potent nonopioid, nonsteroidal anti-inflammatory drug, is an attractive alternative to morphine as many of the opioid-related side effects can be avoided. After Institutional Review Board approval, 25 patients who underwent a primary multilevel lumbar decompression procedure were randomly assigned to receive either Ketorolac or placebo in a double-blinded fashion. After surgery, all patients were allowed to receive intravenous morphine on an as needed basis. Morphine requirements were then recorded immediately postoperative, at 6, 12, and at 24 hours postoperative. A patient's overall hospital course morphine requirement was also assessed. Patient postoperative pain levels were determined using the Visual Analog Pain Scale and were documented at 4, 8, 12, 16, 24, and 36 hours postoperative. There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative Hemovac drain output between study groups. Morphine equivalent requirements were significantly less at all predetermined time points in addition to the overall hospital morphine requirement in patients randomized to receive Ketorolac. Visual Analog Pain Scores were significantly lower in patients randomized to receive Ketorolac immediately postoperative in addition to 4, 12, and 16 hours postoperative. There were no identifiable postoperative complications associated with the use of Ketorolac. CONCLUSION.: Intravenous Ketorolac seems to be a safe and effective analgesic agent following multilevel lumbar decompressive laminectomy. Patients can expect lower morphine requirements and better pain scores throughout their postoperative course.