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Intravenous acetaminophen vs. ketorolac for postoperative analgesia after ambulatory parathyroidectomy.
Scand J Pain 2013; 4(4):249-253SJ

Abstract

Background and methods Minimally invasive parathyroidectomy requires limited analgesia and short recovery times. The preferred post-operative analgesic regimen for this patient population has not been established but non-narcotic components would be quite appropriate. The aim of the study was to determine whether intravenous (IV) acetaminophen (1 g) or ketorolac (30 mg) provide better pain control after parathyroidectomy. A parallel, randomized, double blind, comparative study was completed on 180 patients scheduled for outpatient parathyroidectomy utilizing general anesthesia. Patients were randomized to a blinded administration of either intravenous acetaminophen 1 g or ketorolac 30 mg intra-operatively. Upon arrival but before premedication, baseline pain scores were assessed in all patients. A consecutive series of postoperative pain scores were collected every 15 min using a 10 cm visual analog pain scale (VAS) upon arrival to the post anesthesia care unit (PACU) until discharge by blinded study personnel. Other data collected included: anesthesia time, surgical time, time to discharge, supplemental morphine and postoperative side effects. Results Overall mean postoperative VAS scores were not significantly different between the two treatment groups (p = 0.07). However, ketorolac produced significantly lower pain scores compared with acetaminophen in the later postoperative periods (3.9 ± 1.9 vs. 4.8 ± 2.4 at 45 min, p = 0.009; 3.4 ± 1.7 vs. 4.5 ± 2.1 at 60min, p = 0.04; and 3.2 ± 2.1 vs. 4.4 ± 2.1 at 75 min, p = 0.03). Supplemental morphine was administered to 3 patients in the ketorolac group and 9 patients in the acetaminophen group but total consumption was not significantly different between groups (p = 0.13). The occurrence of nausea was significantly lower in the ketorolac group compared with the IV acetaminophen group (3.4% vs. 14.6%, respectively; p = 0.02). The overall incidence of morphine supplementation, vomiting, headache, muscular pain, dizziness, and drowsiness were not significantly different when compared between the treatment groups. Conclusions Both postoperative regimens provided adequate analgesia but patients receiving ketorolac intraoperatively had significantly lower pain scores at later recovery time points and significantly lower occurrences of nausea. Implications The large volume of patients undergoing parathyroidectomies at our facility warranted a study to develop a standardized postoperative analgesic regimen. We conclude both medications can be utilized safely in this patient population, but there is a slight advantage in pain control with the usage of ketorolac for minimally invasive parathyroidectomies.

Authors+Show Affiliations

Florida Gulf to Bay Anesthesiology Associates LLC, Tampa, FL, United States.Florida Gulf to Bay Anesthesiology Associates LLC, Tampa, FL, United States.Florida Gulf to Bay Anesthesiology Associates LLC, Tampa, FL, United States.Norman Parathyroid Center, Tampa General Hospital, Tampa, FL, United States.Center for Evidence-Based Medicine and Health Outcomes Research, University of South Florida, Tampa, FL, United States.University of North Florida, Nurse Anesthesia Program, Jacksonville, FL, United States.University of North Florida, Nurse Anesthesia Program, Jacksonville, FL, United States.Florida Gulf to Bay Anesthesiology Associates LLC, Tampa, FL, United States.Florida Gulf to Bay Anesthesiology Associates LLC, Tampa, FL, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29913919

Citation

Anand, Amrat, et al. "Intravenous Acetaminophen Vs. Ketorolac for Postoperative Analgesia After Ambulatory Parathyroidectomy." Scandinavian Journal of Pain, vol. 4, no. 4, 2013, pp. 249-253.
Anand A, Sprenker CJ, Karlnoski R, et al. Intravenous acetaminophen vs. ketorolac for postoperative analgesia after ambulatory parathyroidectomy. Scand J Pain. 2013;4(4):249-253.
Anand, A., Sprenker, C. J., Karlnoski, R., Norman, J., Miladinovic, B., Wilburn, B., ... Camporesi, E. (2013). Intravenous acetaminophen vs. ketorolac for postoperative analgesia after ambulatory parathyroidectomy. Scandinavian Journal of Pain, 4(4), pp. 249-253. doi:10.1016/j.sjpain.2013.06.001.
Anand A, et al. Intravenous Acetaminophen Vs. Ketorolac for Postoperative Analgesia After Ambulatory Parathyroidectomy. Scand J Pain. 2013 Oct 1;4(4):249-253. PubMed PMID: 29913919.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intravenous acetaminophen vs. ketorolac for postoperative analgesia after ambulatory parathyroidectomy. AU - Anand,Amrat, AU - Sprenker,Collin J, AU - Karlnoski,Rachel, AU - Norman,James, AU - Miladinovic,Branko, AU - Wilburn,Bruce, AU - Southall,Roger A, AU - Mangar,Devanand, AU - Camporesi,Enrico, Y1 - 2013/10/01/ PY - 2013/04/30/received PY - 2013/06/06/accepted PY - 2018/6/20/entrez PY - 2018/6/20/pubmed PY - 2018/6/20/medline KW - Acetaminophen KW - Acute pain KW - Ketorolac KW - Parathroidectomy KW - Postoperative pain SP - 249 EP - 253 JF - Scandinavian journal of pain JO - Scand J Pain VL - 4 IS - 4 N2 - Background and methods Minimally invasive parathyroidectomy requires limited analgesia and short recovery times. The preferred post-operative analgesic regimen for this patient population has not been established but non-narcotic components would be quite appropriate. The aim of the study was to determine whether intravenous (IV) acetaminophen (1 g) or ketorolac (30 mg) provide better pain control after parathyroidectomy. A parallel, randomized, double blind, comparative study was completed on 180 patients scheduled for outpatient parathyroidectomy utilizing general anesthesia. Patients were randomized to a blinded administration of either intravenous acetaminophen 1 g or ketorolac 30 mg intra-operatively. Upon arrival but before premedication, baseline pain scores were assessed in all patients. A consecutive series of postoperative pain scores were collected every 15 min using a 10 cm visual analog pain scale (VAS) upon arrival to the post anesthesia care unit (PACU) until discharge by blinded study personnel. Other data collected included: anesthesia time, surgical time, time to discharge, supplemental morphine and postoperative side effects. Results Overall mean postoperative VAS scores were not significantly different between the two treatment groups (p = 0.07). However, ketorolac produced significantly lower pain scores compared with acetaminophen in the later postoperative periods (3.9 ± 1.9 vs. 4.8 ± 2.4 at 45 min, p = 0.009; 3.4 ± 1.7 vs. 4.5 ± 2.1 at 60min, p = 0.04; and 3.2 ± 2.1 vs. 4.4 ± 2.1 at 75 min, p = 0.03). Supplemental morphine was administered to 3 patients in the ketorolac group and 9 patients in the acetaminophen group but total consumption was not significantly different between groups (p = 0.13). The occurrence of nausea was significantly lower in the ketorolac group compared with the IV acetaminophen group (3.4% vs. 14.6%, respectively; p = 0.02). The overall incidence of morphine supplementation, vomiting, headache, muscular pain, dizziness, and drowsiness were not significantly different when compared between the treatment groups. Conclusions Both postoperative regimens provided adequate analgesia but patients receiving ketorolac intraoperatively had significantly lower pain scores at later recovery time points and significantly lower occurrences of nausea. Implications The large volume of patients undergoing parathyroidectomies at our facility warranted a study to develop a standardized postoperative analgesic regimen. We conclude both medications can be utilized safely in this patient population, but there is a slight advantage in pain control with the usage of ketorolac for minimally invasive parathyroidectomies. SN - 1877-8879 UR - https://www.unboundmedicine.com/medline/citation/29913919/Intravenous_acetaminophen_vs__ketorolac_for_postoperative_analgesia_after_ambulatory_parathyroidectomy_ L2 - https://www.degruyter.com/doi/10.1016/j.sjpain.2013.06.001 DB - PRIME DP - Unbound Medicine ER -