Toradol to Reduce Ureteroscopy Symptoms Trial (TRUST)
Jamil S Syed1, Amir Khan1, Matthew Goland Van-Ryn1
1Department of Urology, Yale New-Haven Hospital, New Haven, CT.
Urology
|March 22, 2022
Summary
Intraoperative ketorolac (Toradol) significantly reduced narcotic needs for patients undergoing ureteroscopy for kidney stones. This non-steroidal anti-inflammatory drug is an independent predictor of decreased peri-operative morphine milligram equivalent (MME) requirements.
Area of Science:
- Urology
- Anesthesiology
- Pharmacology
Background:
- Nephrolithiasis treatment often involves ureteroscopy, a procedure associated with significant post-operative pain.
- Effective pain management is crucial for patient recovery and satisfaction after ureteroscopy.
- Opioid analgesics are commonly used but carry risks of side effects and dependence.
Purpose of the Study:
- To evaluate the impact of intraoperative intravenous ketorolac on total peri-operative morphine milligram equivalent (MME) consumption in patients undergoing ureteroscopy for nephrolithiasis.
- To determine if ketorolac administration influences intraoperative, postoperative, or combined MME requirements.
- To identify ketorolac use as an independent predictor of MME requirements.
Main Methods:
- A randomized, double-blind study involving 94 patients undergoing ambulatory ureteroscopy for nephrolithiasis.
- Patients were randomized to receive either intraoperative ketorolac or a placebo.
- Morphine milligram equivalent (MME) requirements were calculated for intraoperative, postoperative, and combined periods. Multivariable regression analysis was employed.
Main Results:
- Patients receiving intraoperative ketorolac showed significantly lower intraoperative MME requirements (17.1 vs 24, P < .01).
- The combined peri-operative MME was significantly lower in the ketorolac group (22.2 vs 30.4, P < .02).
- Ketorolac use was an independent predictor of reduced MME requirements (beta coefficient -5.1, P < .01), with no significant difference in complications.
Conclusions:
- Intraoperative ketorolac administration is associated with a substantial reduction (37%) in narcotic requirements during the peri-operative period for ureteroscopy.
- Ketorolac serves as an independent predictor of decreased narcotic needs, supporting its role in pain management.
- Intra-operative ketorolac should be considered in multimodal pain control strategies for ureteroscopy, barring contraindications.
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