Does ketorolac have a preemptive analgesic effect? A randomized, double-blind, control study

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Management

Background:

• Preemptive analgesia aims to reduce postoperative pain by administering analgesics before painful stimuli.
• Ketorolac, a non-steroidal anti-inflammatory drug (NSAID), is often used for its potent analgesic properties.

Purpose of the Study:

• To evaluate the efficacy of preemptive intravenous ketorolac in managing postoperative pain intensity and analgesic consumption.
• To assess the impact of ketorolac on the need for rescue analgesia following mandibular third molar extraction.

Main Methods:

• A randomized, double-blind, placebo-controlled study was conducted on 85 adult patients undergoing mandibular third molar extraction.
• Patients received either 30 mg of intravenous ketorolac or a placebo preoperatively.
• Pain intensity was measured using a visual analog scale (VAS), with time to first analgesic dose and total analgesic requirements as secondary outcomes.

Main Results:

• Patients receiving ketorolac reported lower VAS pain scores at all measured intervals, with statistical significance at 4 hours (P = .01).
• The median interval to rescue medication was longer in the ketorolac group (9.5 hours) compared to the placebo group (7 hours), though not statistically significant (P = .39).
• No statistically significant differences were observed in total analgesic requirements within 72 hours (P = .54) or global patient assessment (P = .22).

Conclusions:

• Preemptive intravenous ketorolac (30 mg) effectively reduced early postoperative pain intensity within the first 8 hours after mandibular third molar extraction.
• While the median time to rescue medication was extended, ketorolac did not lead to a statistically or clinically significant reduction in overall postoperative analgesic consumption.