Use of ketorolac and fentanyl during outpatient gynecologic surgery

In healthy outpatients undergoing minor gynecologic surgery, the analgesic efficacy of ketorolac was compared to fentanyl and to a combination of the two analgesics. One hundred and nine patients were randomly selected to receive fentanyl 50-100 μg, ketorolac 30-60 mg, or a combination of fentanyl 50-100 μg and ketorolac 30-60 mg, intravenously (IV). Anesthesia was induced with midazolam 2 mg IV and propofol 1 mg/kg, IV, and maintained with propofol, 50-160 μg · kg^-1 · min^-1, IV, and nitrous oxide 67% in oxygen via a face mask. Intraoperative anesthetic conditions, recovery times, and postoperative pain and side effects were evaluated. In the ketorolac group, 75% of patients required supplemental fentanyl intraoperatively (mean dose ± SD, 47 ± 54 μg), compared to only 19% (13 ± 30 μg) and 18% (6 ± 15 μg) of patients in the fentanyl and combination groups, respectively. In the ketorolac group, 74% of patients moved in response to surgical stimulation compared to only 16% and 19% of patients in the fentanyl and combination groups, respectively. Although there were no significant differences in intraoperative mean arterial pressure, heart rate, and oxygen saturation of hemoglobin values among the three treatment groups, the ketorolac group manifested significantly more rapid respiratory rates throughout the procedure compared with the fentanyl and combination groups. Recovery times, postoperative side effects, and pain scores, as well as postoperative analgesic and antiemetic requirements, were similar in all three treatment groups. However, the ketorolac group reported significantly higher pain scores in the early postoperative period. In conclusion, ketorolac alone failed to provide adequate intraoperative analgesia and the use of ketorolac in combination with fentanyl did not decrease recovery times or postoperative side effects compared to fentanyl alone in this outpatient population.