Abstract
The objectives of this study were to test the effects of low-dose ketorolac and hydromorphone
added to continuous local anesthetic wound instillation on surgical-site inflammatory
mediators, postoperative pain, and opioid consumption. Sixty healthy women undergoing
cesarean delivery were enrolled in this randomized, double-blinded study. Patients
were randomized to receive a subcutaneous wound instillation of bupivacaine .5% at
10 mg/hour (active control), bupivacaine .5% with ketorolac .6 mg/hour, or bupivacaine
.5% with hydromorphone .04 mg/hour for 48 hours postcesarean. Wound exudate was sampled
at 4, 24, and 48 hours postcesarean and assayed for interleukins IL-1β, IL-2, IL-6,
IL-8, IL-10, and IL-12, tumor necrosis factor (TNF-α), interferon (INF-γ), and granulocyte-macrophage
colony stimulating factor (GM-CSF). The addition of ketorolac to bupivacaine significantly
decreased IL-6 (P = .012) and IL-10 (P = .005) compared to plain bupivacaine. Ketorolac, but not hydromorphone, was associated
with a decrease in pain (P = .018) and analgesic use (P = .020) following cesarean delivery. Our results are compatible with the view that
significant analgesics effects are mediated through local modulation of inflammatory
events. Low-dose ketorolac administered into surgical wounds exert significant anti-inflammatory
and analgesic effects and may be a valuable analgesic alternative to systemic nonsteroidal
anti-inflammatories (NSAIDs) but with potentially fewer side effects.
Perspective
This article demonstrates that low-dose ketorolac administered into wounds modulates
local inflammatory events, decreases postoperative pain, and reduces opioid consumption.
These results suggest that administration of NSAIDs into surgical wounds may be an
analgesic alternative to higher systemic dosing of NSAIDs.
Key words
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Article info
Publication history
Published online: December 06, 2012
Accepted:
October 2,
2012
Received in revised form:
September 16,
2012
Received:
July 12,
2012
Footnotes
This work was supported in part by a Building Interdisciplinary Careers in Women’s Health research grant from the Office of Research on Women’s Health and National Institute of Child Health and Human Development (5K12 HD043452) of the National Institutes of Health (Bethesda, MD); a grant from the Institute of Immunity, Transplantation and Infection of Stanford University School of Medicine (Stanford, CA); and by I-Flow Corporation (Lake Forest, CA).
The authors report no conflicts of interest.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
