Reduced side effects and improved pain management by continuous ketorolac infusion with patient-controlled fentanyl injection compared with single fentanyl administration in pelviscopic gynecologic surgery: a randomized, double-blind, controlled study

Abstract

Background: A combination of opioids and adjunctive drugs can be used for intravenous patient-controlled analgesia (PCA) to minimize opioid-related side effects. We investigated whether two different analgesics administered separately via a dual-chamber PCA have fewer side effects with adequate analgesia than a single fentanyl PCA in gynecologic pelviscopic surgery.

Methods: This prospective, double-blind, randomized, and controlled study included 68 patients who underwent pelviscopic gynecological surgery. Patients were allocated to either the dual (ketorolac and fentanyl delivered by a dual-chamber PCA) or the single (fentanyl alone) group. Postoperative nausea and vomiting (PONV) and analgesic quality were compared between the two groups at 2, 6, 12, and 24 h postoperatively.

Results: The dual group showed a significantly lower incidence of PONV during postoperative 2-6 h (P = 0.011) and 6-12 h (P = 0.009). Finally, only two patients (5.7%) in the dual group and 18 (54.5%) in the single group experienced PONV during the entire postoperative 24 h and could not maintain intravenous PCA (odds ratio: 0.056, 95% CI [0.007, 0.229], P < 0.001). Despite the administration of less fentanyl via intravenous PCA during the postoperative 24 h in the dual group than in the single group (66.0 ± 77.8 vs. 383.6 ± 70.1 μg, P < 0.001), postoperative pain had no significant intergroup difference.

Conclusions: Two different analgesics, continuous ketorolac and intermittent fentanyl bolus, administered via dual-chamber intravenous PCA, showed fewer side effects with adequate analgesia than conventional intravenous fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.

Keywords: Analgesia; Fentanyl; Ketorolac; Patient-controlled analgesia; Postoperative nausea and vomiting; Postoperative pain.

Fig. 1.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the patients. Dual group: ketorolac and fentanyl delivered by a dual-chamber PCA, Single group: fentanyl alone delievered by a PCA. PCA: patientcontrolled analgesia.

Fig. 2.

The incidence distribution of PONV in both groups. Dual group: ketorolac and fentanyl delivered by a dual-chamber PCA, Single group: fentanyl alone delievered by a PCA. PACU: post-anesthesia care unit, PONV: postoperative nausea and vomiting, PCA: patient-controlled analgesia, NA: not available. ^*Five patients in the single group discontinued the intravenous PCA at postoperative 2–6 h. ^†Two patients in the dual group and 13 patients in the single group discontinued the intravenous PCA at postoperative 6–12 h.

Fig. 3.

Postoperative NRS for pain in both groups. Dual group: ketorolac and fentanyl delivered by a dual-chamber PCA, Single group: fentanyl alone delievered by a PCA. PACU: post-anesthesia care unit, NRS: numerical rating scale. ^*P < 0.001 vs. NRS at PACU of each group.