BACKGROUND: Nonsteroidal antiinflammatory drugs are commonly used to treat postoperative and chronic pain. Animal studies suggest that these drugs act, in part, by blocking prostaglandin production in the spinal cord. The authors tested intrathecal ketorolac in patients with chronic or postoperative pain. METHODS: After approval of the institutional review board and the Food and Drug Administration, three clinical studies were performed. First, 15 patients receivingchronic intrathecal morphine received 0.5-2.0 mg of intrathecal ketorolac. Second, 12 patients receivingchronic intrathecal morphine received, in a double-blinded, randomized, cross-over design, intrathecal saline or 2.0 mg of ketorolac, with pain intensity as the primary outcome measure. Third, 30 patients undergoing total vaginal hysterectomy received, in a double-blinded, randomized, controlled design, intrathecal saline or 2.0 mg of ketorolac, with bupivacaine with time to first morphine dose after surgery as the primary outcome measure. RESULTS:Patients with chronic pain had many symptoms before intrathecal injection, without worsening of these symptoms from ketorolac. Pain intensity was reduced by intrathecal ketorolac, but this did not differ from placebo. In the first study, pain was reduced by intrathecal ketorolac in patients with high cerebrospinal fluid prostaglandin E2 concentrations but not in those with normal concentrations. Intrathecal ketorolac did not alter time to first morphine after surgery. CONCLUSIONS:Intrathecal ketorolac did not relieve chronic pain or extend anesthesia or analgesia from intrathecal bupivacaine administered at the beginning of surgery. Under the conditions of these studies, it seems that spinal cylcooxygenase activity does not contribute to chronic or postoperative pain.
RCT Entities:
BACKGROUND: Nonsteroidal antiinflammatory drugs are commonly used to treat postoperative and chronic pain. Animal studies suggest that these drugs act, in part, by blocking prostaglandin production in the spinal cord. The authors tested intrathecal ketorolac in patients with chronic or postoperative pain. METHODS: After approval of the institutional review board and the Food and Drug Administration, three clinical studies were performed. First, 15 patients receiving chronic intrathecal morphine received 0.5-2.0 mg of intrathecal ketorolac. Second, 12 patients receiving chronic intrathecal morphine received, in a double-blinded, randomized, cross-over design, intrathecal saline or 2.0 mg of ketorolac, with pain intensity as the primary outcome measure. Third, 30 patients undergoing total vaginal hysterectomy received, in a double-blinded, randomized, controlled design, intrathecal saline or 2.0 mg of ketorolac, with bupivacaine with time to first morphine dose after surgery as the primary outcome measure. RESULTS:Patients with chronic pain had many symptoms before intrathecal injection, without worsening of these symptoms from ketorolac. Pain intensity was reduced by intrathecal ketorolac, but this did not differ from placebo. In the first study, pain was reduced by intrathecal ketorolac in patients with high cerebrospinal fluid prostaglandin E2 concentrations but not in those with normal concentrations. Intrathecal ketorolac did not alter time to first morphine after surgery. CONCLUSIONS: Intrathecal ketorolac did not relieve chronic pain or extend anesthesia or analgesia from intrathecal bupivacaine administered at the beginning of surgery. Under the conditions of these studies, it seems that spinal cylcooxygenase activity does not contribute to chronic or postoperative pain.
Authors: Asokumar Buvanendran; Jeffrey S Kroin; Richard A Berger; Nadim J Hallab; Chiranjeev Saha; Corina Negrescu; Mario Moric; Marco S Caicedo; Kenneth J Tuman Journal: Anesthesiology Date: 2006-03 Impact factor: 7.892
Authors: Sharon Bingham; Paul J Beswick; Chas Bountra; Terry Brown; Ian B Campbell; Iain P Chessell; Nick Clayton; Sue D Collins; Philip T Davey; Helen Goodland; Norman Gray; Claudine Haslam; Jonathan P Hatcher; A Jacqueline Hunter; Fiona Lucas; Graham Murkitt; Alan Naylor; Elizabeth Pickup; Becky Sargent; Scott G Summerfield; Alexander Stevens; Sharon C Stratton; Joanne Wiseman Journal: J Pharmacol Exp Ther Date: 2004-11-30 Impact factor: 4.030
Authors: Pepijn D D M Roelofs; Rick A Deyo; Bart W Koes; Rob J P M Scholten; Maurits W van Tulder Journal: Spine (Phila Pa 1976) Date: 2008-07-15 Impact factor: 3.468
Authors: Steve Shackelford; Richard Rauck; Steve Quessy; David Blum; Rachel Hodge; Richard Philipson Journal: J Pain Date: 2009-05-05 Impact factor: 5.820
Authors: Sonja L Joksimovic; Srdjan M Joksimovic; Vesna Tesic; Agustin García-Caballero; Simon Feseha; Gerald W Zamponi; Vesna Jevtovic-Todorovic; Slobodan M Todorovic Journal: Sci Signal Date: 2018-08-28 Impact factor: 8.192
Authors: Erica J Weinstein; Jacob L Levene; Marc S Cohen; Doerthe A Andreae; Jerry Y Chao; Matthew Johnson; Charles B Hall; Michael H Andreae Journal: Cochrane Database Syst Rev Date: 2018-06-20
Authors: R A R Drake; J L Leith; F Almahasneh; J Martindale; A W Wilson; B Lumb; L F Donaldson Journal: J Neurosci Date: 2016-08-31 Impact factor: 6.167
Authors: Lu Wang; Maria Bauer; Regina Curry; Anders Larsson; Daniel I Sessler; James C Eisenach Journal: J Anesth Date: 2014-02-18 Impact factor: 2.931
Authors: Erica J Weinstein; Jacob L Levene; Marc S Cohen; Doerthe A Andreae; Jerry Y Chao; Matthew Johnson; Charles B Hall; Michael H Andreae Journal: Cochrane Database Syst Rev Date: 2018-04-25
Authors: Jennifer Luk; Yong Lu; Amanda Ackermann; Xiaoxue Peng; Diane Bogdan; Michelino Puopolo; David E Komatsu; Simon Tong; Iwao Ojima; Mario J Rebecchi; Martin Kaczocha Journal: J Pain Res Date: 2018-03-05 Impact factor: 3.133