The safety and efficacy of intravenous ketorolac in patients undergoing primary endoscopic sinus surgery: A randomized, double-blinded clinical trial

Background: Ketorolac (KT) is an intravenous (IV) nonsteroidal anti-inflammatory drug (NSAID) for acute, moderate pain. KT is safe, but may be linked to increased risk of post-tonsillectomy hemorrhage. The safety and efficacy of KT following primary endoscopic sinus surgery (ESS) is unknown. Methods: All patients underwent primary ESS and septoplasty. Patients randomly received either IVKT 30 mg or IV fentanyl (IVF) 25 μg postprocedure. Postoperative pain was recorded at 0, 30, and 60 minutes via visual analog scale (VAS), and patients received as needed fentanyl and hydrocodone/acetaminophen for additional pain. Postoperative bleeding questionnaires were completed on postoperative days 1 and 7 (POD 1 and POD 7). Preoperative and POD 7 hemoglobin was assessed. Results: A total of 34 patients enrolled in the study over 1 year. Sixteen patients received IVKT and 18 patients received IVF. The average time of administration was 23 ± 6 minutes postprocedure. There were no significant differences in preoperative and postoperative hemoglobin levels between groups and bleeding assessments. There were no incidences of postoperative hemorrhage. There was no significant difference in pain VAS between the IVKT and IVF groups (3.5, 3.2, 2.1 vs 3.0, 4.4, 3.8 at 0, 30, and 60 minutes, respectively). There was no significant difference between the number of doses of supplemental analgesics for the IVKT and IVF groups (2.0 vs 3.4 doses IV; 1.0 vs 1.4 doses orally, respectively). Conclusion: In this study, IVKT was a safe analgesic in the setting of primary ESS. There was no increased risk of hemorrhage or acute blood-loss anemia. IVKT did not appear to offer statistically significant pain control over IVF. © 2012 ARS-AAOA, LLC.