Comparison of analgesic effects of intravenous and intranasal ketorolac in patients with mandibular fracture-A Randomized Clinical Trial

Javad Yazdani, Reza Khorshidi-Khiavi, Saeed Nezafati, Ali Mortazavi, Farrokh Farhadi, Farhad Nojan, Milad Ghanizadeh, Javad Yazdani, Reza Khorshidi-Khiavi, Saeed Nezafati, Ali Mortazavi, Farrokh Farhadi, Farhad Nojan, Milad Ghanizadeh

Abstract

Background: Similarity of pharmacokinetics of intranasal ketorolac to the intravenous form and other advantages have promoted its application. This study compared the analgesic effects of intravenous and intranasal ketorolac in patients undergoing mandibular fracture surgery.

Material and methods: In this clinical trial study, Sixty-four patients with unilateral mandibular fracture were divided randomly into two groups. In group 1, 30 mg of intravenous (IV) ketorolac was injected every 8 hours and in group 2, intranasal (IN) ketorolac spray was used as a 100-µL puff in each nostril (31.5 mg) every 6 hours. After each patient regained consciousness, pain intensity was measured based on visual analogue scale for 48 hours. Finally, the total dose of the opioid analgesic agent (pethidine) and the time for the first request for an analgesic agent were recorded for each patient, and their means were compared in each group with proper statistical tests.

Results: Mean pain intensity of patients at baseline was significantly higher than that at other intervals and then, it decreased significantly (P<0.001). Furthermore, 2, 4, 6 and 8 hours after surgery, mean pain intensity in the IN group was significantly lower than that in the IV group (P<0.05). In the IN group, dose of antinociceptive medicine was slightly higher and the time to request it was shorter than the other group, but it was not statistically significant (P >0.05).

Conclusions: Application of intranasal ketorolac spray decreased pain after mandibular fracture surgery, especially at 8-hour interval after surgery, decreasing the need for opioids. Key words:Ketorolac, intranasal, intravenous, mandibular fracture.

Conflict of interest statement

Conflict of interest statement:All Authors disclose any conflict of interest.

Copyright: © 2019 Medicina Oral S.L.

Figures

Figure 1
Figure 1
The CONSORT Flow diagram of study patients.

References

    1. Shankariah M, Mishra M, Kamath RA. Tramadol versus ketorolac in the treatment of postoperative pain following maxillofacial surgery. J Maxillofac Oral Surg. 2012;11:264–70.
    1. Shoar S, Esmaeili S, Safari S. Pain management after surgery: a brief review. Anesth Pain Med. 2012;1:184–6.
    1. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101:5–22.
    1. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377:2215–25.
    1. Becker DE. Pain management: Part 1: Managing acute and postoperative dental pain. Anesth Prog. 2010;57:67–78.
    1. Allen SC, Ravindran D. Perioperative Use of Nonsteroidal Anti-Inflammatory Drugs. Clin Drug Investig. 2009;29:703–11.
    1. Joris J. Efficacy of nonsteroidal antiinflammatory drugs in postoperative pain. Acta Anaesthesiol Belg. 1996;47:115–23.
    1. Nezafati S, Khiavi RK, Mirinejhad SS, Ammadi DA, Ghanizadeh M. Comparison of Pain Relief from Different Intravenous Doses of Ketorolac after Reduction of Mandibular Fractures. J Clin Diagn Res. 2017;11:6–10.
    1. Rooks WH 2nd. The pharmacologic activity of ketorolac tromethamine. Pharmacotherapy. 1990;10:30–2.
    1. De Oliveira GS Jr, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg. 2012;114:424–33.
    1. Brown C, Moodie J, Bisley E, Bynum L. Intranasal ketorolac for postoperative pain: a phase 3, double-blind, randomized study. Pain Med. 2009;10:1106–14.
    1. Grant GM, Mehlisch DR. Intranasal ketorolac for pain secondary to third molar impaction surgery: a randomized, double-blind, placebo-controlled trial. J Oral Maxillofac Surg. 2010;68:1025–31.
    1. Bockow R, Korostoff J, Pinto A, Hutcheson M, Secreto SA, Bodner L. Characterization and treatment of postsurgical dental implant pain employing intranasal ketorolac. Compend Contin Educ Dent. 2013;34:570–6.
    1. Moodie JE, Brown CR, Bisley EJ, Weber HU, Bynum L. The safety and analgesic efficacy of intranasal ketorolac in patients with postoperative pain. Anesth Analg. 2008;107:2025–31.
    1. He A, Hersh EV. A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level. Curr Med Res Opin. 2012;28:1873–80.
    1. Alexander R, El-Moalem HE, Gan TJ. Comparison of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery. J Clin Anesth. 2002;14:187–92.
    1. Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 2008;101:700–4.
    1. Akhtar MI, Saleem M, Zaheer J. Wound infiltration with Bupivacaine versus Ketorolac for postoperative pain relief in minor to moderate surgeries. J Pak Med Assoc. 2009;59:385–8.
    1. Buvanendran A, Kroin JS, Tuman KJ, Lubenow TR, Elmofty D, Moric M. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of function after knee replacement: a randomized controlled trial. JAMA. 2003;290:2411–8.
    1. White PF, Sacan O, Tufanogullari B, Eng M, Nuangchamnong N, Ogunnaike B. Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery. Can J Anaesth. 2007;54:342–8.
    1. McAleer SD, Majid O, Venables E, Polack T, Sheikh MS. Pharmacokinetics and safety of ketorolac following single intranasal and intramuscular administration in healthy volunteers. J Clin Pharmacol. 2007;47:13–8.
    1. Gillis JC, Brogden RN. Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetic properties and therapeutic use in pain management. Drugs. 1997;53:139–88.
    1. Singla N, Singla S, Minkowitz HS, Moodie J, Brown C. Intranasal ketorolac for acute postoperative pain. Curr Med Res Opin. 2010;26:1915–23.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren