ketorolac and Anesthesia studies

Ketorolac: A pyrrolizine carboxylic acid derivative structurally related to INDOMETHACIN. It is an NSAID and is used principally for its analgesic activity. (From Martindale The Extra Pharmacopoeia, 31st ed)
ketorolac : A racemate comprising equimolar amounts of (R)-(+)- and (S)-(-)-5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid. While only the (S)-(-) enantiomer is a COX1 and COX2 inhibitor, the (R)-(+) enantiomer exhibits potent analgesic activity. A non-steroidal anti-inflammatory drug, ketorolac is mainly used (generally as the tromethamine salt) for its potent analgesic properties in the short-term management of post-operative pain, and in eye drops to relieve the ocular itching associated with seasonal allergic conjunctivitis. It was withdrawn from the market in many countries in 1993 following association with haemorrhage and renal failure.
5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid : A member of the class of pyrrolizines that is 2,3-dihydro-1H-pyrrolizine which is substituted at positions 1 and 5 by carboxy and benzoyl groups, respectively.

Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.

Research Excerpts

Excerpt	Relevance	Reference
"Fifty-four ASA I and II children 1 to 10 yr of age undergoing strabismus surgery were randomized to receive in a double-blind fashion intravenous ketorolac (0."	9.08	The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. ( Guarnieri, KM; Mendel, HG; Sundt, LM; Torjman, MC, 1995)
"The efficacy of intraoperatively administered ketorolac for the prophylactic treatment of pain in the postanesthesia care unit (PACU) was examined in a prospective, double-blinded study."	9.07	Effect of intraoperative ketorolac on postanesthesia care unit comfort. ( Behrman, KH; Disbrow, EA; Hanowell, LH; Loeb, RG; Valdrighi, JB, 1994)
"We evaluated the effect of ketamine-xylazine-acepromazine anesthesia (31."	7.73	Ketamine-xylazine-acepromazine anesthesia and postoperative recovery in rats. ( Huerkamp, MJ; Kinkead, B; Nemeroff, CB; Plotsky, PM; Thrivikraman, K; Welberg, LA, 2006)
"Two cases of bradycardia following the intra-operative use of ketorolac given intravenously (i."	7.69	Bradycardia following intravenous ketorolac in children. ( Foster, PN; Williams, JG, 1997)
"Fifty-four ASA I and II children 1 to 10 yr of age undergoing strabismus surgery were randomized to receive in a double-blind fashion intravenous ketorolac (0."	5.08	The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. ( Guarnieri, KM; Mendel, HG; Sundt, LM; Torjman, MC, 1995)
"The efficacy of intraoperatively administered ketorolac for the prophylactic treatment of pain in the postanesthesia care unit (PACU) was examined in a prospective, double-blinded study."	5.07	Effect of intraoperative ketorolac on postanesthesia care unit comfort. ( Behrman, KH; Disbrow, EA; Hanowell, LH; Loeb, RG; Valdrighi, JB, 1994)
"We evaluated the effect of ketamine-xylazine-acepromazine anesthesia (31."	3.73	Ketamine-xylazine-acepromazine anesthesia and postoperative recovery in rats. ( Huerkamp, MJ; Kinkead, B; Nemeroff, CB; Plotsky, PM; Thrivikraman, K; Welberg, LA, 2006)
"Two cases of bradycardia following the intra-operative use of ketorolac given intravenously (i."	3.69	Bradycardia following intravenous ketorolac in children. ( Foster, PN; Williams, JG, 1997)
"Ellagic acid is a major compound found in certain fruits and nuts."	1.36	The effect of ellagic acid on platelet activation as measured by the quantification of P-selectin using flow cytometry. ( Attilio, P; Kane, N; Merritt, C; O'Sullivan, J; Sims, J, 2010)

Research

Studies (9)

Authors

Clinical Trials (2)

Trial Overview

Trial Outcomes

Anti-emetic Doses

Timeframe	Studies, this research(%)	All Research%
pre-1990	0 (0.00)	18.7374
1990's	6 (66.67)	18.2507
2000's	2 (22.22)	29.6817
2010's	1 (11.11)	24.3611
2020's	0 (0.00)	2.80

Authors	Studies
Attilio, P	1
Merritt, C	1
Sims, J	1
Kane, N	1
O'Sullivan, J	1
Welberg, LA	1
Kinkead, B	1
Thrivikraman, K	1
Huerkamp, MJ	1
Nemeroff, CB	1
Plotsky, PM	1
Jackson, LM	1
Hill, RJ	1
Blackburn, A	1
Stevens, JD	1
Wheatley, RG	1
Madej, TH	1
Hunter, D	1
Mendel, HG	1
Guarnieri, KM	1
Sundt, LM	1
Torjman, MC	1
Valdrighi, JB	1
Hanowell, LH	1
Loeb, RG	1
Behrman, KH	1
Disbrow, EA	1
Monagle, J	1
Wongprasartsuk, P	1
Shearer, W	1
Foster, PN	1
Williams, JG	1
Hall, SR	1
Milne, B	1
Loomis, C	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
Prospective Evaluation of the Effects of IV Ketorolac on Platelet Function Post-Cesarean Delivery[NCT03805607]	Phase 4	40 participants (Actual)	Interventional	2021-01-18	Active, not recruiting
A Prospective, Randomized, Control Trial of Ketorolac Versus Placebo on Opioid Analgesic Use, Estimated Blood Loss and Complications Following Cesarean Delivery With Epidural Morphine[NCT02509312]	Phase 4	70 participants (Actual)	Interventional	2016-05-31	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Total doses of medications to treat pruritus (opioid side-effect) including ondansetron and promethazine. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Corrected Change in Hct on POD1.

Intervention	doses (Median)
Ketorolac	0
Placebo	0

Corrected change in Hct on POD1. Performed by subtracting POD1 Hct from POD0 Hct. Correction for transfusion by further subtracting 3 per unit of pRBC transfused to account for the typical change seen per unit transfused. (NCT02509312)
Timeframe: POD1

Estimated Blood Loss (EBL)

Intervention	mg/dl (Mean)
Ketorolac	-5.1
Placebo	-3.5

Estimation of blood loss during surgery (NCT02509312)
Timeframe: Immediately post-op

Post-Partum Hemorrhage

Intervention	ml (Median)
Ketorolac	900
Placebo	800

Rate of Post-Partum Hemorrhage between groups during the first 24 hours pst-partum. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Pruritus Doses

Intervention	Participants (Count of Participants)
Ketorolac	7
Placebo	4

Total doses of medications to treat pruritus (opioid side-effect) including diphenhydramine, nalbuphine and naloxone. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Total Hydromorphone Dose

Intervention	doses (Median)
Ketorolac	0
Placebo	0

Total hydromorphone doses in mg in the first 24 hours post-partum. (NCT02509312)
Timeframe: 0 - 24 hours post-partum.

Units of Packed Reb Blood Cell Transfused

Intervention	mg (Median)
Ketorolac	0
Placebo	0.2

Total number of Units of Packed Reb Blood Cell Transfused in intra-op until 24 hours post-partum. (NCT02509312)
Timeframe: Intra-op until 24 hours post-partum.

Uterotonic Doses

Intervention	units of pRBCs (Median)
Ketorolac	0
Placebo	0

Total number of uterotonic doses including methylergonovine, carboprost and misoprostol. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Change in Pain Score Post-Cesarean Delivery

Intervention	doses (Median)
Ketorolac	0
Placebo	0

Pain score post-Cesarean Delivery using 11-point numerical rating scale (NRS): 0-10 where 0 is no pain and 10 is the worst pain imaginable (NCT02509312)
Timeframe: Up to 24 hours post-cesarean delivery

Percentile Change in Diastolic Blood Pressure (DBP) at 6,12, and 24 Hours

Intervention	units on NRS (Median)
	Baseline	15 mins	1 hour	6 hours	12 hours	24 hours
Ketorolac	0	0	0	1	2	4.5
Placebo	0	0	0	3	3.5	5.5

Percentile change in diastolic Blood Pressure at 6,12, and 24 hours for each patient's baseline defined by immediate post-op PACU vitals. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Percentile Change in Systolic Blood Pressure at 6,12, and 24 Hours

Intervention	Percent change (Mean)
	6 hours	12 hours	24 hours
Ketorolac	12.30	8.8	12.0
Placebo	7.6	8.8	11.1

Percentile change in Systolic Blood Pressure at 6,12, and 24 hours for each patient's baseline defined by immediate post-op PACU vitals. (NCT02509312)
Timeframe: 0 - 24 hours post-partum

Article	Year
Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery. Journal of clinical anesthesia, 1995, Volume: 7, Issue:2 Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Anesthesia; Double	1995
Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery. Journal of clinical anesthesia, 1995, Volume: 7, Issue:2 Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Anesthesia; Double	1995
Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery. Journal of clinical anesthesia, 1995, Volume: 7, Issue:2 Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Anesthesia; Double	1995
Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery. Journal of clinical anesthesia, 1995, Volume: 7, Issue:2 Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Anesthesia; Double	1995
The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. Anesthesia and analgesia, 1995, Volume: 80, Issue:6 Topics: Acetaminophen; Ambulatory Surgical Procedures; Analgesics, Non-Narcotic; Anesthesia; Child; Child, P	1995
Effect of intraoperative ketorolac on postanesthesia care unit comfort. Journal of pain and symptom management, 1994, Volume: 9, Issue:3 Topics: Adult; Analgesics; Anesthesia; Double-Blind Method; Female; Humans; Intraoperative Care; Ketorolac;	1994
Ketorolac versus fentanyl for gynaecological day-case surgery. The Australian & New Zealand journal of obstetrics & gynaecology, 1993, Volume: 33, Issue:4 Topics: Adult; Ambulatory Surgical Procedures; Anesthesia; Female; Fentanyl; Genital Diseases, Female; Human	1993

Article	Year
The effect of ellagic acid on platelet activation as measured by the quantification of P-selectin using flow cytometry. AANA journal, 2010, Volume: 78, Issue:6 Topics: Anesthesia; Animals; Cyclooxygenase 2; Cyclooxygenase Inhibitors; Dietary Supplements; Drug Evaluati	2010
Ketamine-xylazine-acepromazine anesthesia and postoperative recovery in rats. Journal of the American Association for Laboratory Animal Science : JAALAS, 2006, Volume: 45, Issue:2 Topics: Acepromazine; Anesthesia; Anesthetics, Combined; Animals; Animals, Laboratory; Anti-Inflammatory Age	2006
Hill block, a modification of the Bier block. Journal of clinical anesthesia, 2006, Volume: 18, Issue:5 Topics: Anesthesia; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Foot; Hand; Humans; Ketorol	2006
Bradycardia following intravenous ketorolac in children. European journal of anaesthesiology, 1997, Volume: 14, Issue:3 Topics: Analgesics, Non-Narcotic; Anesthesia; Bradycardia; Child; Female; Humans; Injections, Intravenous; I	1997
Spinal action of ketorolac, S(+)- and R(-)-ibuprofen on non-noxious activation of the catechol oxidation in the rat locus coeruleus: evidence for a central role of prostaglandins in the strychnine model of allodynia. Anesthesiology, 1999, Volume: 90, Issue:1 Topics: Anesthesia; Animals; Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Catechols; Electrophys	1999

ketorolac and Anesthesia